Rediscovering Hormone Replacement Therapy in Menopause: Understandingthe Balance of Benefits and Risks through Landmark Studies
Selma Jusufovic1,2,3 Edin Medjedovic4,5 Asim Kurjak6
1 Clinic for Endocrinology and Diabetology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
2 Department of Endocrinology, ASA Hospital, Sarajevo, Bosnia and Herzegovina
3 Internal Medicine Department, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
4 Clinic of Gynecology and Obstetrics, Clinical University Center Sarajevo, Sarajevo, Bosnia and Herzegovina
5 Department of Gynecology and Obstetrics, Faculty of Medicine University of Sarajevo, Sarajevo, Bosnia and Herzegovina
6 Department of Obstetrics and Gynecology, University hospital “Sveti Duh”, Zagreb, Croatia
Corresponding Author: Selma Jusufovic, MD PhD, Clinic for Endocrinology and Diabetology, Clinical Centre University of Sarajevo, Bosnia and Herzegovina; E-mail: selma.jusufovic@gmail.com; Phone: +38766711970; ORCID ID: 0009-0002-3085-6750
Cite this article: Jusufovic S, Medjedovic E, Kurjak A. Rediscovering Hormone Replacement Therapy in Menopause: Understanding the Balance of Benefits and Risks through Landmark Studies. Sar Med J. 2025; 2(1): Online ahead of print. 
10.70119/0023-25
Pages: -/ Published online: 29 January 2025
Original submission: 10 September 2024; Revised submission: 15 December 2024; Accepted: 30 December 2024
Abstract
Menopause represents an inevitable transition in a woman’s life, presenting with vasomotor symptoms, mood disorders, sleep difficulties, and prolonged risks such as osteoporosis and cardiovascular diseases. Hormone replacement therapy emerged as the cornerstone of menopausal management, particularly for alleviating symptoms and preventing postmenopausal osteoporosis.
However, findings from the Women’s Health Initiative (WHI) study in 2002 highlighted increased risks of breast cancer, cardiovascular disease, and stroke associated with hormonal replacement treatment, leading to a significant global decline in its usage. Consequently, numerous women were deprived of essential therapy, endangering their health and quality of life.
This review presents the findings of the WHI study, discusses its methodological errors, and evaluates its benefits and harms. We explore landmark studies that have reestablished the benefits and risks of hormone replacement therapy over the past two decades. Guidelines supported by these findings are presented in this review.
Despite advancements, public perception of hormone replacement treatment remains influenced by outdated findings, limiting its utilization in many regions, especially in developing countries . Our objective is to provide evidence that misconceptions about hormone replacement therapy significantly impact women’s general health and quality of life, as well as to clarify the short-term and long-term impacts of hormone replacement therapy.
We conclude that hormonal replacement treatment is effective and safe when administered according to established guidelines. Access to information, coupled with knowledgeable physicians who consistently interact with women, is as vital as the contributions of menopause healthcare specialists. Conflicting information from outdated professionals can likely lead to treatment failure in patients.
Keywords: menopause, women’s health, estrogens, progestins, quality of life.
