The American Heart Association has updated its recommendation regarding hormone replacement therapy (HRT). Their current recommendation states that physicians should not base the decision to use HRT based upon heart disease prevention. This recommendation is the result of a number of relatively recent studies refuting earlier data about the protective effects of HRT on the cardiovascular system.

Most gynecologists prescribe HRT for the treatment of menopause symptoms, such as hot flashes, vaginal dryness, and sleep disturbances. However, from 1995 until 1999 the American Heart Association had recommended that physicians consider estrogen for all postmenopausal women with cardiovascular disease.

Currently, there is no concrete evidence that HRT prevents heart disease in healthy post-menopausal women. In contrast, there has been a number of recent studies that show no improvement in women using HRT who have cardiovascular disease.

In light of the change in HRT recommendations and ongoing studies, the pattern of HRT use may change over the next 3 to 5 years. Initially, women may use HRT for symptom relief of hot flashes, vaginal dryness, and sleep disturbances. After 5-10 years of use, there will be a number of options. These options will be based upon evidence at that time, as well as assessment of current medical problems. For instance, if osteoporosis is suspected or diagnosed, specific medications aimed at treatment may be recommended. Cardiovascular protection will be afforded with lifestyle changes, such as smoking cessation and dietary/exercise modifications. Aggressive treatment with cholesterol lowering agents in high risk women will continue.

This will allow a tailoring of treatments and recommendations for each individual women as she makes the transition through the postmenopausal years.