“Nuance” is Important When Discussing Hormone Replacement Therapy

The use of hormone replacement therapy for women has become a controversial topic since the publication of the Women’s Health Initiative study more than 20 years ago

March 31, 2025

Roswell Park Comprehensive Cancer Center

At a Glance

Category	Detail
Condition	Hormone Replacement Therapy (HRT)
Key Mechanisms	Supplementation of estrogen and/or progesterone to compensate for lack of ovarian production.
Target Population	Women with primary ovarian insufficiency, medically induced menopause, and natural menopause.
Care Setting	Oncology and gynecology practices.

Key Highlights

Women with primary ovarian insufficiency are not included in the Women's Health Initiative study.
HRT can significantly reduce risks of cardiac morbidity and osteoporosis in younger women.
Topical estrogen is effective for treating vaginal symptoms in breast cancer patients.
Transdermal HRT options have a lower risk of venous thromboembolism.
Combined oral contraceptives can be used for hormone replacement in women with primary ovarian insufficiency.

Guideline-Based Recommendations

Diagnosis

Assess for primary ovarian insufficiency in women under 40 with symptoms.

Management

Consider HRT for women with primary ovarian insufficiency to mitigate risks of cardiac events and osteoporosis.

Monitoring & Follow-up

Monitor for side effects and adjust HRT doses as necessary.

Risks

Evaluate the risk of hyperplasia and cancer in women with an intact uterus when prescribing HRT.

Patient & Prescribing Data

Women experiencing menopause due to primary ovarian insufficiency or cancer treatment.

Vaginal estrogen can be safely used in breast cancer patients with minimal systemic absorption.

Clinical Best Practices

Discuss the risk-benefit ratio of HRT with patients, especially those with a history of breast cancer.
Utilize transdermal HRT to reduce the risk of venous thromboembolism.
Incorporate progesterone in HRT for women with an intact uterus.