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Recent studies concerning the long-term use of HRT indicate substantial risk for cardiovascular disease, venous thromboembolism (blood clots), and invasive breast cancer.

Cardiovascular disease
Current scientific studies indicate that hormone replacement therapy increases the risk for cardiovascular disease, stroke, and heart attack, especially during the first year of treatment. Dietary and lifestyle changes (e.g., stop smoking, exercise) are important to ensure healthy menopausal years.

Blood Clots
HRT increases the risk for blood clots causing pulmonary embolism. This risk continues throughout the course of the treatment.

Osteoporosis
ERT may be prescribed for menopausal women who are at risk for osteoporosis. Estrogen supplementation can slow or halt bone loss; however, the following limitations apply:

• ERT must be started within 5 years of menopause to provide protection from fracture.
• Bone loss is rapid when ERT is discontinued (bone density levels drop to those of a woman who has not been on ERT).
• Long-term therapy (5-10 years) is required to provide protection from fractures.

Cancer
Recent studies show that HRT decreases the risk for colorectal cancer, but long-term treatment increases the risk for invasive breast cancer. Doctors prescribe ERT based on an individual risk-benefit ratio; that is, they must consider whether the benefits of HRT outweigh the risk for cancer.

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