Hormone Replacement Therapy: Changing Guidelines, Changing Practice
Bibliographic record
Abstract
In the past decade our knowledge about the benefits and risks of hormone replacement therapy (HRT) has evolved substantially. This paper reviews these changes and their impact on published clinical practice guidelines. In the early 1990s, HRT was strongly recommended to all postmenopausal women for short-term use in the treatment of menopausal symptoms, and for long-term use in the prevention and treatment of osteoporosis and the prevention of cardiovascular disease. The risk of breast cancer associated with HRT was considered small enough to be of little consequence in comparison to its purported benefits. Data from three large RCTs were published during the late 1990s and early 2000s - the PEPI trial, the HERS trial, and the WHI trial. In summary, these trials have shown increases in breast cancer (9 per 10,000 postmenopausal women per year) and cardiovascular events (7 coronary artery events and 8 strokes per 10,000 postmenopausal women per year) that may not be balanced by the decreases in menopausal symptoms and osteoporotic fractures (57 fewer total fractures per 10,000 postmenopausal women per year) in women taking HRT. These findings have led to changes in clinical practice guidelines for HRT use. Current guidelines recommend against the use of HRT solely for the primary or secondary prevention of cardiovascular disease, and caution against its use for the sole purpose of osteoporosis prevention or treatment. Short-term relief of menopausal symptoms remains a relatively acceptable indication for HRT, however any prescription of HRT should be accompanied by a detalied discussion of its potential risks and benefits.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.128 | 0.276 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.003 | 0.010 |
| Scholarly communication | 0.011 | 0.019 |
| Open science | 0.007 | 0.006 |
| Research integrity | 0.020 | 0.032 |
| Insufficient payload (model declined to judge) | 0.006 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".