THE MYTHOLOGY OF HORMONE REPLACEMENT THERAPY

Objective To evaluate the literature on contraindications contained in pharmaceutical data sheets of five currently available oestrogen repl acement preparations (HRT). These contraindications include cardiovasc ular disease, diabetes, liver diseases, otosclerosis, endometriosis, m elanoma and hormone-dependent tumours. Design Systematic review. Inter ventions Oestrogen replacement regimens. Results The contraindications to the five HRT preparations have been taken uncritically from the da ta sheets of oral contraceptives. In some of these conditions not only is HRT not contraindicated, it is indicated. The data sheets for the HRT preparations all state that cardiovascular disease is a contraindi cation, but systematic review shows that ischaemic heart disease, hype rtension and hyperlipidaemia are not contraindications, and in ischaem ic heart disease HRT may actually be indicated. Similarly, systematic review shows that diabetes, chronic liver disease, endometriosis, some cases of treated cancer of the endometrium and breast, melanoma and o tosclerosis are not contraindications to HRT. Conclusions The informat ion in the pharmaceutical data sheets of HRT regimens should be modifi ed as more accurate information could influence how these preparations are prescribed by doctors as well as affect patient compliance.