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Current Evidence of the Oncological Benefit-Risk Profile of Hormone Replacement Therapy

Hormone replacement therapy (HRT) remains the most effective treatment for menopausal symptoms and has been shown to prevent bone loss and fracture. The progestogen is added to provide endometrial protection in women with an intact uterus. After the publication of the initial WHI (Women’s Health Ini...

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Autores principales: D’Alonzo, Marta, Bounous, Valentina Elisabetta, Villa, Michela, Biglia, Nicoletta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780494/
https://www.ncbi.nlm.nih.gov/pubmed/31500261
http://dx.doi.org/10.3390/medicina55090573
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author D’Alonzo, Marta
Bounous, Valentina Elisabetta
Villa, Michela
Biglia, Nicoletta
author_facet D’Alonzo, Marta
Bounous, Valentina Elisabetta
Villa, Michela
Biglia, Nicoletta
author_sort D’Alonzo, Marta
collection PubMed
description Hormone replacement therapy (HRT) remains the most effective treatment for menopausal symptoms and has been shown to prevent bone loss and fracture. The progestogen is added to provide endometrial protection in women with an intact uterus. After the publication of the initial WHI (Women’s Health Initiative) results in 2002 reporting an overall increased risk of breast cancer, many women discontinued HRT. Despite the re-analysis of the results by subgroups of patients and updates with extended follow-up, much controversy remains, which we will analyze later in the text. Different types of estrogen or progestogen, as well as different formulations, doses, and durations, may play a role in HRT’s effects on breast tissue. Evidence states that conjugated equine estrogen (CEE), compared to estro-progestin therapy, shows a better profile risk (HR 0.79, CI 0.65–0.97) and that, among different type of progestins, those structurally related to testosterone show a higher risk (RR 3.35, CI 1.07–10.4). Chronic unopposed endometrial exposure to estrogen increases the risk of endometrial hyperplasia and cancer, whereas the association with progestins, especially in continuous combined regimen, seems to reduce the risk (RR 0.71, CI 0.56–0.90). HRT was also associated with a protective effect on colon cancer risk (HR 0.61, CI 0.42–0.87). Data about ovarian and cervical cancer are still controversial.
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spelling pubmed-67804942019-10-30 Current Evidence of the Oncological Benefit-Risk Profile of Hormone Replacement Therapy D’Alonzo, Marta Bounous, Valentina Elisabetta Villa, Michela Biglia, Nicoletta Medicina (Kaunas) Review Hormone replacement therapy (HRT) remains the most effective treatment for menopausal symptoms and has been shown to prevent bone loss and fracture. The progestogen is added to provide endometrial protection in women with an intact uterus. After the publication of the initial WHI (Women’s Health Initiative) results in 2002 reporting an overall increased risk of breast cancer, many women discontinued HRT. Despite the re-analysis of the results by subgroups of patients and updates with extended follow-up, much controversy remains, which we will analyze later in the text. Different types of estrogen or progestogen, as well as different formulations, doses, and durations, may play a role in HRT’s effects on breast tissue. Evidence states that conjugated equine estrogen (CEE), compared to estro-progestin therapy, shows a better profile risk (HR 0.79, CI 0.65–0.97) and that, among different type of progestins, those structurally related to testosterone show a higher risk (RR 3.35, CI 1.07–10.4). Chronic unopposed endometrial exposure to estrogen increases the risk of endometrial hyperplasia and cancer, whereas the association with progestins, especially in continuous combined regimen, seems to reduce the risk (RR 0.71, CI 0.56–0.90). HRT was also associated with a protective effect on colon cancer risk (HR 0.61, CI 0.42–0.87). Data about ovarian and cervical cancer are still controversial. MDPI 2019-09-07 /pmc/articles/PMC6780494/ /pubmed/31500261 http://dx.doi.org/10.3390/medicina55090573 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
D’Alonzo, Marta
Bounous, Valentina Elisabetta
Villa, Michela
Biglia, Nicoletta
Current Evidence of the Oncological Benefit-Risk Profile of Hormone Replacement Therapy
title Current Evidence of the Oncological Benefit-Risk Profile of Hormone Replacement Therapy
title_full Current Evidence of the Oncological Benefit-Risk Profile of Hormone Replacement Therapy
title_fullStr Current Evidence of the Oncological Benefit-Risk Profile of Hormone Replacement Therapy
title_full_unstemmed Current Evidence of the Oncological Benefit-Risk Profile of Hormone Replacement Therapy
title_short Current Evidence of the Oncological Benefit-Risk Profile of Hormone Replacement Therapy
title_sort current evidence of the oncological benefit-risk profile of hormone replacement therapy
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780494/
https://www.ncbi.nlm.nih.gov/pubmed/31500261
http://dx.doi.org/10.3390/medicina55090573
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