The future of HRT
Objective: This work sets forth the current status and perspectives of HRT.
Material and methods: In total, 547 medical works dealing with this subject are evaluated.
Results: The beneficial effect of estrogens on the lipids, as well as the antagonistic influence of progestogens, have long been known.
After MWS, HERS and WHI, the beneficial effects on several organs the arterial system included have been confirmed. Currently, it is clear that the sooner HRT is established, the better.
The ASRM have recently published a matched 10 000/10 000 study reporting Alzheimer diminishment by 34% and only an eight case (41/33) increase in breast cancer diagnoses. This small increase is related by several works to continuous, but not cyclic, therapy and does not exist in Japanese women; this is thus attributed to a western life style. Tobacco tar was once blamed for this increase, because it yields alquilestrogens in the first passage of estrogens through the liver; percutaneous administration of estradiol prevents this increase in breast cancer frequency and also thromboenbolism peril.
In addition, when HRT is given in cycles, using bio-identical hormones, the carcinogenic effect is non-existent; continuous dosage stimulates breast and PRL secretion, the contribution of which latter to breast cancer growth is now well known.
Presently, lung cancer is attributed to HRT; this is surprising because the lung is not a hormonal target organ, but estrogen receptors were reported by these authors to be found in the lung.
Male HRT is commended by most authors, however, PSA, prostate size, and red blood cells must be controlled.
Conclusion: The cyclic therapy with bio-identical hormones via the skin might be the future of HRT, because it is the safest method and permits longer use of the HRT, solving the problems of breast cancer increase and thromboembolism.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.