Postmenopausal Hormone-Replacement Therapy

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.Patient 1 is a 52-year-old woman at average risk for breast cancer and osteoporosis who is having menopause-related hot flashes and disturbed sleep. Patient 2 is a 58-year-old woman with osteopenia whose mother had breast cancer. Patient 3 is a 65-year-old woman with a history of coronary revascularization and documented osteoporosis. Each wants to know whether hormone-replacement therapy is right for her.The Clinical ProblemOverviewOne of the most complex and difficult health care decisions that women face is whether to use postmenopausal hormone-replacement therapy. The average woman in the United States lives nearly 30 years after menopause, . . .