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Review: risks and benefits of HRT comparing various sources of evidence

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 QUESTION: What are the benefits and harms of hormone replacement therapy (HRT) for primary prevention of cardiovascular disease, thromboembolism, osteoporosis, cancer, dementia, and cholecystitis?

Data sources

Studies were identified by searching Medline (1966–2001), HealthSTAR (1975–2001), and the Cochrane Controlled Trials Register; reviewing bibliographies of relevant studies, reviews, and editorials; and contacting experts.

Study selection

Studies were selected if they included a comparison group of HRT non-users and reported data relating to HRT use and clinical outcomes of interest. Studies were excluded if the sample was selected according to previous events or conditions associated with higher risks of targeted outcomes.

Data extraction

Data were extracted on study design and type of HRT (unopposed oestrogen or oestrogen plus progestin). 2 reviewers independently assessed study quality as good, fair, or poor using the US Preventive Services Task Force criteria.

Main results

The findings of the meta-analyses (relative risks) for some outcome categories are summarised in the table with corresponding hazard ratios from the recent Women’s Health Initiative (WHI). The results of the meta-analysis showed that HRT reduced the risk of wrist fractures, vertebral fractures, …

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  • For correspondence: Dr H D Nelson, Oregon Health and Science University, Portland, OR, USA. nelsonh{at}

  • Abstract and commentary also appear in ACP Journal Club.

  • Sources of funding: Agency for Healthcare Research and Quality and Portland Veterans Affairs Medical Center Women’s Health Fellowship.