Hormone Replacement Therapy – A Review

Volume 9, Issue 1, February 2024     |     PP. 120-136      |     PDF (242 K)    |     Pub. Date: August 5, 2019
DOI:    261 Downloads     2438 Views  


Asha K Rajan, Department of Pharmacy practice, Jaya College of paramedical sciences, Chennai, India
Vedha pal Jeyamani.S, Department of Pharmacy practice, Jaya College of paramedical sciences, Chennai, India
Swarna Priya Basker, Department of Pharmacy practice, Jaya College of paramedical sciences, Chennai, India
Kaviya.U, Department of Pharmacy practice, Jaya College of paramedical sciences, Chennai, India
Merlin Joan Of Arc. M.C, Department of Pharmacy practice, Jaya College of paramedical sciences, Chennai, India
Elizabeth Benita.S, Department of Pharmacy practice, Jaya College of paramedical sciences, Chennai, India

Sexual hormones are of essential importance for reproduction and later in life for metabolism, cardiovascular system and general well being of women. Menopause leads to a multiple loss of functions with decrease in estrogen, progesterone levels particularly in regions of brain, bone, skin, connective tissue, peripheral vessels and cardiovascular system. Alterations in this systems result in an increase in oxidation, weakened lipid metabolism, resulting in high cholesterol levels with increased risk of systemic disorders. Thus it becomes mandatory at times to consider a long term HRT with progestins and estrogens. Diabetic women’s making use of HRT is more befitted on their blood glucose and cholesterol levels. Tibolone and Progestrone plus Estradiol therapy is more befitted for therapy against breast cancer when compared to estrogen therapy alone. Thus the proper use of HRT in short duration would be befitted when compared to long term use leading to many complications of the same.

Breast cancer, Hormone replacement therapy, Estrogen, Progestrone.

Cite this paper
Asha K Rajan, Vedha pal Jeyamani.S, Swarna Priya Basker, Kaviya.U, Merlin Joan Of Arc. M.C, Elizabeth Benita.S, Hormone Replacement Therapy – A Review , SCIREA Journal of Clinical Medicine. Volume 9, Issue 1, February 2024 | PP. 120-136.


[ 1 ] Salpeter S.R, Walsh J.M, Greyber E, Ormiston T.M, Salpeter E.E. Mortality associated with hormone replacement therapy in younger and older women: a meta-analysis. J Gen Intern Med. 2004,19:791-804.
[ 2 ] Hammar M, Christau S, Nathorst-Boos J, Rud T, Garre K. A double-blind, randomized trial comprising the effects of tibolone and continuous combined hormone replacement therapy in post menopausal women with menopausal symptoms. Br J Obster Gynecol. 1998, 105:904-911.
[ 3 ] Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B et al. Randomised trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and estrogen/progestin replacement study (HERS) research group. JAMA. 1998, 280:605-613.
[ 4 ] Kloosterboer HJ. Tibolone: a steroid with a tissue specific mode of action. J Steroid Biochem Mol Biol. 2001, 76:231-238.
[ 5 ] Grodstein F, Stampfer MJ, Colditz GA, Willet WC, Mnason JE, Joffe M et al. Postmenopausal hormone therapy and mortality. N Engl J Med. 1997, 336:1769-1775.
[ 6 ] Delmas PD, Davis SR, Hensen J, Adami S, van Os S, Nijland EA. Effects of tibolone and raloxifene on bone mineral density in osteopenic postmenopausal women. Osteoporosis Int. 2008, 19:1153-1160.
[ 7 ] Nelson HD, Fu R, Griffin JC, Nygren P, Smith ME, Humphrey L. systematic review: comparative effectiveness of medictions to reduce risk of breast cancer. Ann Intern Med. 2009, 151:703-715, W-226-235.
[ 8 ] Archer DF, Hendrix S, Gallagher JC, Rymer J, Skouby S, Ferenczy A et al. endometrial effects of tibolone. J Clin Endocrinol Metab. 2007, 92:911-918.
[ 9 ] Swanson SG, Drosman S, Helmond FA, Stathopoulus VM. Tibolone for the treatment of moderate to severe vasomotor symptoms and genital atrophy in postmenopausal women: a multi-centre, randomized, double-blind, placebo-controlled study. Menopause. 2006, 13:917-925.
[ 10 ] Speroff L. The million women study and breast cancer. Maturitas. 2003, 46:1-6.
[ 11 ] Shapiro S. The million women study: potential biases do not allow uncritical acceptance of the data [editorial]. Climacteric. 2004, 7:3-7.
[ 12 ] Glass AG, Lacey JV, Carreon D, Hoover RN. Breast cancer incidence: combined roles of menopausal hormone therapy, screening mammography and estrogen status. J Natl Cancer Inst. 2007, 99:1152-1161.
[ 13 ] Ravdin PM, Cronin KA, Howlader N et al. The decrease in breast cancer incidence in 2003 in the United States. N Engl J Med. 2007, 356:1670-1674.
[ 14 ] Wren BG. The origin of breast cancer. Menopause. 2007, 14:1060-1068.
[ 15 ] Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985, 312:146-151.
[ 16 ] Carter CL, Corle DK, Micozzi MS et al. A prospective study of the development of breast cancer in 16, 692 women with benign breast disease. Am J Epidemiol. 1988, 128:467-477.
[ 17 ] Tavassoli FA, Norris HJ. A comparison of the results of long term fellow up for atypical intraduct hyperplasia and intraduct hyperplasia of the breast. Cancer. 1990, 65:518-529.
[ 18 ] Hartman LC, sellers TA, Frost MH et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005, 353:229-237.
[ 19 ] Hanahan D, Weinberg R. The hallmarks of cancer. Cell. 2000, 100:57-70.
[ 20 ] Welch HG, Black WC. Using autopsy series to estimate the disease reservoir for ductal carcinoma in situ of the breast. Ann Intern Med. 1997, 127:1023-1028.
[ 21 ] Bartow SA, Pathak DR, Black WC et al. prevalence of benign, atypical and malignant breast lesions in populations at different risk for breast cancer. Cancer. 1987, 60:2751-2760.
[ 22 ] Jemal A, Ward E Thun M. Recent trends in breast cancer incidence rates by age and tumor characteristics among US women. Breast Cancer Res. 2007, 9:108.
[ 23 ] Canfell K, Banks E, Mao AM, Beral IV. Decrease in breast cancer incidence following a rapid fall in use of hormone replacement therapy in Australia. Med J Aust. 2008, 188:641-644.
[ 24 ] Colditz GA. Decline in breast cancer incidence due to removal of promoter: combination estrogen plus progestin. Breast Cancer Res. 2007, 9:108-112.
[ 25 ] Chen WY, Colditz GA, Rosner B et al. Unopposed estrogen therapy and the risk of breast cancer. Arch Intern Med. 2006, 166:1027-1032.
[ 26 ] Clarke CA, Glasser SL, Uratsu CS et al. Recent declines in hormone therapy utilization and breast cancer incidence: clinical and population based evidence. J Clin Oncol, 2006, 24: 49-50.
[ 27 ] Kennedy DL, Baum C, Forbes MB. Noncontraceptive estrogens and progestin: use patterns over time. Obstet Gynecol. 1985,65:441-6.
[ 28 ] Ernster VL, Bush TL, Huggins GR et al. Benefits and risks of menopausal estrogen and/or progestin hormone use. Prev Med. 1988,17:201-23.
[ 29 ] Hunt K, Vessey M, McPherson K. Mortality in a cohort of long term users of hormone replacement therapy: an updated analysis. Br J Obstet Gynaecol. 1990, 97:1080-6.
[ 30 ] Lindsay R, Cosman F Nieves J. Estrogen: effects and actions in osteoporosis. Osteoporosis Int. 1993, 3:150-2.
[ 31 ] Wilson PWF, Garrison RJ, Castelli WP. Postmenopausal estrogen use, cigarette smoking and cardiovascular morbidity in women over 50: the Framingham study. N Engl J Med. 1985 313:1038-43.
[ 32 ] Bush TL, Barrett-Connor E, Cowan LD et al. Cardiovascular mortality and noncontraceptive use of estrogen in women: results from the lipid research clinics program follow-up study. Circulation. 1987, 75:1102-9.
[ 33 ] Egeland GM, Matthews KA, Kuller LH et al. Characteristics of noncontraceptive hormone users. Prev Med. 1988, 17:403-11.
[ 34 ] Harris RB, Laws AA, Reddy VM et al. Are women using postmenopausal estrogen? A community survey. Am J Public Health. 1990,80:1266-8.
[ 35 ] Derby CA, Hume AL, Barbour MM et al. Correlates of postmenopausal estrogen use and trends through the 1980s in two southeastern new England communities. Am J Epidemiol. 1993,137:1125-35.
[ 36 ] Johannes CB, Crawford SL, Posner JG et al. Longitudinal patterns and correlates of hormone replacement therapy use in middle aged women. Am J Epidemiol. 1994, 140:439-52.
[ 37 ] Grabrick DM, Hartmann LC, Cerhan JR, Vierkant RA, Therneau TM, Vachon CM et al. Risk of breast cancer with oral contraceptive use in women with a family history of breast cancer. J Am Med Assoc. 2000, 284:1791-8.
[ 38 ] Lambe M, Hsieh C, Trichopoulos D, Ekbom A, Pavia M, Adami HO. Transient increase in the risk of breast cancer after giving birth. N Eng J Med. 1994, 33:5-9.
[ 39 ] Guinea VF, Oisson H, Moller T, Hess KR, Taylor SH, Fahey T et al. Effect of pregnancy on prognosis for young women with breast cancer. Lancet. 1994, 3443:1587-9.
[ 40 ] Marsden J, Sacks NM. Hormone replacement therapy and breast cancer. Endocr Relat Cancer. 1996, 3:81-97.
[ 41 ] Helewa M, Levesque P, Provencher D. Breast cancer, pregnancy and breastfeeding. J Obstet Gynaecol Can. 2002, 24:164-71.
[ 42 ] Li Ci, Malone KE, Porter PL, Weiss NS, Tang MTC, Cushing Haugen KL et al. Relationship between long duration and different regimens of hormone therapy and risk of breast cancer. J Am Med Assoc. 2003, 289:3254-63.
[ 43 ] Ross RK, Paganini Hill, Wan PC, Pike MC. Effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin. J Natl Cancer Inst. 2000, 4:328-32.