SUMMARY

* Recently, new evidence regarding the use of hormone replacement therapy (HRT) in postmenopausal women has been published. These data are from observational studies, or trials using surrogate markers of disease. Large-scale, randomised, controlled trials using clinical end-points are under way, and should clarify the risks and benefits associated with HRT use.

* The benefits of using HRT in the longer term include a reduced risk of osteoporosis and, possibly, of coronary heart disease (CHD). Short-term use of HRT relieves symptoms associated with the climacteric, such as hot flushes or vaginal atrophy.

* When used for longer than five years, HRT may be associated with an increased risk of breast and endometrial cancer. HRT users may also have an increased risk of venous thromboembolism (VTE) in the first year of use.

* There is little evidence of an increased risk of breast cancer associated with use of HRT for less than five years. Women can be reassured that the short-term use of HRT, e.g. for the relief of menopausal symptoms, does not appear to increase the risk of breast cancer.

* As CHD is the major cause of death in UK women, the potential benefit from a reduction in the incidence of CHD in postmenopausal women is considerable. Lifestyle changes should also be encouraged in an attempt to reduce CHD and osteoporosis.

* Women should be made aware of the data available regarding the relative risks and benefits of HRT and its limitations. The ultimate decision to use HRT should reside with the woman. This choice may be influenced by her own values and circumstances.