PATIENT-SPECIFIC DECISIONS ABOUT HORMONE REPLACEMENT THERAPY IN POSTMENOPAUSAL WOMEN

Objective.-To examine the effect of hormone replacement therapy on lif e expectancy in postmenopausal women with different risk profiles for heart disease, breast cancer, and hip fracture. Design.-Decision analy sis using a Markov model, Published regression models were used to lin k risk factors to disease incidence and to estimate the lifetime risks of developing coronary heart disease (CHD), breast cancer, hip fractu re, and endometrial cancer, The impact of hormone therapy on disease i ncidence was estimated from published epidemiologic studies. Setting.- Mathematical model applicable to primary care, Interventions.-Treatmen t with hormone replacement therapy or no hormone replacement therapy. Main Outcome Measure.-Life expectancy. Results.-Hormone replacement th erapy should increase life expectancy for nearly all postmenopausal wo men, with some gains exceeding 3 years, depending mainly on an individ ual's risk factors for CHD and breast cancer, For women with at least 1 risk factor for CHD, hormone therapy should extend life expectancy, even for women having first-degree relatives with breast cancer, Women without any risk factors for CHD or hip fracture, but who have 2 firs t-degree relatives with breast cancer, however, should not receive hor mone therapy. Conclusions.-The benefit of hormone replacement therapy in reducing the likelihood of developing CHD appears to outweigh the r isk of breast cancer for nearly all women in whom this treatment might be considered, Our analysis supports the broader use of hormone repla cement therapy.