HRT should be recommended for perimenopausal women and those with premature menopause, a review of current research shows.

Published  in Obstetrician & Gynaecologist, the study highlights the benefits of HRT for younger women heading into menopause and symptomatic women under 45.

Women with premature ovarian insufficiency should be strongly advised to consider taking HRT until the average menopausal age of 51.4 years, the UK authors say, noting that this age group is prone to an earlier onset of both CVD episodes and osteoporosis.

“The risk of breast cancer with HRT use in these women is deemed to be no greater than the population risk for their age, while the benefits are greater by prevention of long-term morbidity,” write the researchers.

“Hence it is strongly advised that these women should consider taking HRT, at least until the age of 50.”

Bisphosphonates are not considered first-line treatment for these patients, say the researchers led by Dr Shagaf Bakour, a consultant gynaecologist at City Hospital in Birmingham.

They say HRT is effective for symptomatic perimenopausal women. “To avoid unnecessary investigation of unscheduled bleeds, these women should be commenced on sequential (cyclical) HRT (that is continuous oestrogen with progestogen for 12-14 days per month).

“If periods are reasonably frequent, then HRT should start with the next bleed, but if infrequent then HRT can be commenced without awaiting a period.”

Once established on HRT, they say an annual review is all that is necessary.

“HRT does not increase blood pressure and there is no indication to monitor more frequently.”

For the younger woman who still hopes for sporadic ovulation, Dr Bakour and colleagues suggest sequential therapy can be continued until this hope becomes unrealistic.

“No doctor should be concerned about discussing the risks and benefits of HRT with women who have menopausal symptoms,” the researchers write