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Understanding and Explaining Hormone Therapy Risk part 1

Risk is actually a very difficult concept to understand. It is also open to abuse and misinterpretation. Yet the decision a woman faces to use hormones or not, if clinically indicated, is entirely based on her concept of risk or how the data are presented to her.
It is crucial that clinicians charged with the health care of postmenopausal women understand the basic concepts of risk in order to communicate the potential benefits and risks of HT and other therapies. Risk is defined as the possibility or chance of harm; it does not indicate that harm will occur.
Calculating Risk
Risk calculations provide a basis by which healthcare providers and patients can weigh the pros and cons of initiating or continuing therapy. Understanding the concepts "relative risk," "absolute risk," and "statistical significance" is essential to interpreting risk.
This means that compared with postmenopausal women not using ET, the risk of DVT for those using ET is twice that of a nonuser in the study.

This means that for every 10,000 postmenopausal women who use ET, there would be 11 additional cases of DVT per year of ET use.
Vasomotor Symptoms
ET (or EPT for women with an intact uterus) is the gold standard for treatment of vasomotor-related symptoms (hot flashes and night sweats) and hence the drug of choice, provided there is no reason not to prescribe.
Vaginal Symptoms
The cause of vaginal atrophy–related symptoms is estrogen deficiency, and the most appropriate treatment is local ET. Low-dose intermittent application of local ET is exceptionally safe and there is little evidence for adverse effects.
Sexual Function
Local ET is excellent for dyspareunia (painful intercourse). There is little evidence that ET or EPT will aid sexual desire disorder, so the latter is not an indication for ET/EPT.
Urinary Health
In the presence of vaginal atrophy, local ET is recommended for symptoms of frequency and urgency in the absence of painful urination. If the latter is present, suspect a urinary tract infection and treat accordingly. ET may be of value in reducing recurrent episodes of the latter.
There is no evidence to support systemic ET or EPT for the alleviation of true stress urinary incontinence.
Change in Body Weight/Mass
Reassure women that current HT usage is not a cause of weight gain.
Quality of Life (QOL)
There is, however, good evidence for an improvement in health-related QOL in symptomatic women treated with hormones. My own research and clinical experience also make me believe that true global QOL -- the sense of enhanced well-being -- is positively affected by HT, but I will concede that further research remains necessary.
Osteoporosis
I do not believe that there can be any doubt that HT reduces bone loss and fractures at all sites, even in women who were not bone deficient at the time of commencing therapy. Whether HT is prescribed for this indication, however, is one of the biggest challenges facing the clinician in balancing risk and benefit to the individual woman.

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