Hormone replacement therapy: an update.

Ever since menopause was causally linked to several symptoms and disease processes, the concept of hormone replacement therapy (HRT) took root and was widely practiced over half a century. We have witnessed the rise and fall of the HRT during these years. While the life expectancy has improved enormously, the average age of menopause has not changed, and hence a vast majority of women spend one third of their lives in the state of estrogen deficiency. The long-term problems of menopause, therefore, are important to the present times. It is rather interesting to study the changing trends in hormonal management of menopause. There was a time when menopause was managed without hormones because of lack of knowledge. This was followed by selective use of HRT and then the wide and universal use of HRT, only to realize the emergence of health risks related to HRT. Hence, the approach had to be changed again. After having gone through these changes, we seem to have completed the cycle and stand at a point not far away from where we began, but with a lot of knowledge and conclusions. The main pathbreaking trial has been the Women’s Health initiative (WHI) [1] trial in the year 2002. It has changed clinical practice and has led us toward a more rational interpretation of the place of hormone therapy in menopause management.