Assessing benefits and risks of hormone therapy in 2008: new evidence, especially with regard to the heart.

Observational studies, including the observational component of the Women's Health Initiative, consistently found that women who chose to use menopausal hormone therapy (HT) had a reduction in mortality and cardiovascular disease incidence relative to women who did not use HT. Randomized controlled trials have taught us that initiation of HT in older women (> 60 years old) remote from menopause (> 10 years since menopause) potentially has more risk than benefit. Additionally, randomized controlled trials have confirmed observational studies indicating the safety and benefit of HT in young (< 60 years old) recently menopausal women (< 10 years since menopause). In other words, we have come full circle in our understanding of HT, with a caveat concerning initiation in older women. Importantly, the magnitude and types of risk associated with HT are similar to those of other commonly used therapies. These data have led to recommendations that the benefits of HT exceed the risks when initiated in menopausal women younger than 60 years.