Where are we now with hormone replacement therapy?
Menopausal symptoms can be grim, and the desire to replace the hormonal "deficit" with exogenous hormones remains strong. Since the 1950s, hormone replacement therapy has been used increasingly, while evidence on the risks of unwanted side effects has accumulated. What have we learned over these decades? Firstly, current biological theory does not predict the effects of hormones on cancer and cardiovascular disease well. Secondly, mass prescription requires large randomised clinical trials with long follow-ups. Observational studies of the putative effect of drugs, for coronary disease especially are unreliable. Thirdly, moss markets engender massive vested interests--personal, departmental, and corporate. Genuine care for women demands scientific independence, since uncertainty allows expert, but illegitimate, conviction too easily The balance now seems clearer than it was before we knew these risks; hormone replacement therapy works for symptoms but not for future health, which is not what had been widely promised. It can take decades to detect important and unanticipated side effects of medications reliably Do the current regulatory provisions adequately provide for the sensible avoidance of more, tragic episodes? Regulators and legislators will be contemplating the implications, as they did after thalidomide, and hopefully we will not get the marketing so wrong again.