Hormone Replacement Therapy: Is It Always Necessary in Natural and Surgical Menopause?

The aim of this paper is to delve into the multifaceted effects of hormone replacement therapy (HRT) in postmenopausal women, elucidating its therapeutic benefits and potential risks. HRT demonstrates efficacy in alleviating genitourinary and vasomotor symptoms, enhancing sleep, mitigating myalgias, addressing skin issues, bolstering emotional well-being, improving joint health, and enhancing overall quality of life. Moreover, HRT exerts a positive influence on bone density, thereby reducing the incidence of osteoporotic fractures. However, we also scrutinize the associated risks, including heightened susceptibility to cardiovascular disease, breast cancer, ovarian cancer, and thromboembolic events. The administration method and dosage of hormones emerge as pivotal factors in modulating these risks. Furthermore, we explore the impact of genetic factors on thromboembolic events in women undergoing oral estrogen therapy. Additionally, considerations regarding the duration of HRT treatment are discussed, with annual reassessment advocated, albeit lacking consensus on optimal treatment duration. We also examine the implications of oophorectomy, delineating potential hormonal dysfunction post-hysterectomy and its ramifications. Moreover, we investigate the cardiovascular and lipid profile effects of ovarian conservation post-hysterectomy, suggesting potential advantages over oophorectomy. In conclusion, this is a comprehensive overview of both the benefits and risks entailed in HRT utilization among postmenopausal women, thereby facilitating informed decision-making in clinical practice.