Conclusion

The established indications for prescribing

HRT are well defined: symptom relief and

consequent improvement of quality of life.

The prevention of bone fractures and

CHD events remains controversial. Although

several studies have demonstrated the benefits

of oestrogen in decreasing postmenopausal

bone loss, only a few prospective studies have

shown actual prevention of fractures. For

CHD the findings from observational studies

are strong and consistent but several biases

have been identified, the strongest of which is

compliance bias. Although the secondary

prevention trial of the HERS group showed

no benefit for HRT in women with CHD

using a given hormonal regimen, we should

not extrapolate and refute the benefits of

treatment as a primary prevention in normal

postmenopausal women. The ongoing trials in

a low-risk population should provide answers

for the same hormonal regimen as in

HERS. Other large trials running in Europe

may indicate the effects of different hormone

regimens.