Intended for healthcare professionals

Clinical Review

Making decisions about hormone replacement therapy

BMJ 2003; 326 doi: (Published 08 February 2003) Cite this as: BMJ 2003;326:322
  1. Janice Rymer (, senior lecturera,
  2. Ruth Wilson, professorb,
  3. Karen Ballard, director of postgraduate studiesc
  1. a Guy's, King's and St Thomas's School of Medicine, Guy's and St Thomas's Hospital Trust, London SE1 7EH
  2. b Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
  3. c Department of General Practice and Primary Care, Guy's, King's and St Thomas's School of Medicine, King's College London SE11 6SP
  1. Correspondence to: J Rymer, Department of Obstetrics and Gynaecology, St Thomas's Hospital, London SE1 7EH

    Many women will at some stage consider taking hormone replacement therapy, but uncertainty about the risks and benefits makes this decision difficult

    Since hormone replacement therapy was introduced 70 years ago, a steady flow of studies has produced evidence of both harmful and beneficial effects. Recent British studies have shown that 60% of women aged 51–7 years have taken hormone replacement therapy,1 with 45% having tried it by the time they are 50.2 In the United States, about 38% of postmenopausal women take hormone replacement therapy. In 2000, 46 million prescriptions were written for Premarin (conjugated equine oestrogens), making it the second most frequently prescribed drug in the United States.3

    Women are increasingly encouraged to participate in making decisions about hormone replacement therapy. However, the complexity and uncertainty of information about the treatment can make it difficult for women to make a decision, increasing their reliance on medical advice.4 The publication of the heart and oestrogen-progestin replacement study (HERS)5 and women's health initiative (WHI)6 study, both of which found adverse effects, has added to the confusion. In this article, we define who should be offered hormone replacement therapy and why, describe the reasons why women may wish to take hormone replacement therapy, and clarify the advantages and disadvantages of treatment.

    Summary points

    Hormone replacement therapy can improve the quality of life of women with hypo-oestrogenic symptoms

    Long term hormone replacement therapy should be offered to women at high risk of osteoporosis or with established osteoporosis

    Hormone replacement therapy should not be offered for prevention of cardiovascular disease or to women with a high risk of cardiovascular disease

    Long term treatment is associated with increased incidence of breast cancer

    Women should be counselled about the risks, benefits, and uncertainties of hormone replacement therapy before deciding to start …

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