Recommended Course of Treatment.
Different forms of HRT are designed to meet the unique medical profiles of women seeking treatment. Generally, the most beneficial form of HRT is a combination estrogen-progesterone prescription delivered through a patch.
As women age, accelerated loss of bone increases the risk of fractures and breaks. This is especially a concern for petite women who are prone to have smaller bones. Studies done on behalf of the Swedish Fracture Study Group have found combined estrogen-progesterone HRT to decrease the likelihood of hip fracture in menopausal women. Continuous treatment with HRT was shown to be increasingly beneficial, however after discontinuation of therapy HRT does not retain any long term protective effects. HRT delivered orally and transdermally were found to be equally effective (Michaelsson et al., 1998). Other studies have shown that menopausal women using HRT have 7.7% more articular knee cartilage than non users (Wluka et al., 2001). Even at doses below the standard dose, long term use of estrogen-progesterone therapy has been shown to increase bone mass (Hashimoto et al., 2001). The findings of these studies collectively suggest that HRT protects women from loss of cartilage and bone and may offer protection from the development of osteoporosis. .
A major disadvantage of HRT is its link to increased incidence of endometrial cancer. This is an important consideration for women undergoing natural menopause who have in tact uterus and ovaries. Recent studies have shown that cancer occurrence caused by HRT depends on the hormones prescribed, dose and duration of treatment. Estrogen replacement therapies have been shown to be the most risky form of HRT, having an estimated relative risk odds ratio (OR) of 6.6 after five years of treatment. The addition of progesterone for 10-16 days per cycle decreased the OR to 1.6. However, HRT administering continuous progesterone and estrogen had an OR for endometrial cancer of only 0.