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[quote=Anonymous][quote=Anonymous]From what i understand, estrogen only reduces a bunch of risks and raises uterine cancer risk.

Adding progesterone counters uterine cancer risk but increases breast cancer risk, even at low doses.

I haven’t seen data on overall quality of life and longevity.

I am sitting on the sidelines (45 with hot flashes, no other bothersome symptoms) and waiting for some more data.

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I'm not on the sidelines but also have no interest in convincing anyone to take HRT. To be clear, the current USPSTF guidelines allow for a woman with no other health conditions but "bothersome" menopause symptoms to take HRT in the lowest dose, and for the shortest amount of time that can be tolerated. It does bother me that this is the guideline, given what the studies actually show when you consider all of it. So:

-Uterine cancer: There is broad agreement that unopposed estrogen (that is, estrogen without progesterone) causes uterine cancer. The only way to take estrogen alone is to first get a hysterectomy.

-Breast cancer: There is not broad agreement that progesterone causes breast cancer. The Women's Health Initiative data was originally said to show an increased risk of breast cancer for combined estrogen and progesterone (this risk was one additional case of breast cancer per thousand -- that is, not statistically significant -- but no additional deaths). It appears now that this risk was actually a result of the [i]unusually low incidence of breast cancer[/i] in women in the placebo group who had previously taken HRT. Additionally, the form of HRT taken in the WHI was conjugated equine estrogen plus the progestogen medroxyprogesterone acetate, which are rarely used now. Due to the hysteria over the WHI, the current forms will likely never be tested in a large randomized controlled trial, and the USPSTF has rejected reliance on the many observational studies or further analysis (specifically, dividing the cohorts by time since menopause and whether they had previously taken HRT). The WHI estrogen-only group had a 40% reduction in breast cancer incidence.

-Bone health: There is broad agreement that HRT reduces osteoporosis while you are taking it.

-Dementia: When divided up by age at which HRT is started, HRT increases the risk of dementia if it is started more than 10 years after menopause. Started earlier, the risk of dementia is decreased in comparison to a placebo. This protective effect continues even when the HRT is continued into late life.

-Heart health: There are inconsistent results on the extent to which HRT is protective in the first 10 years after menopause. One study showed a 44% reduction in incidence while the WHI study showed a small but not statistically significant benefit. For HRT started more than 10 years after menopause, cardiovascular risk goes up, at least with oral estrogens (which are rarely used today). The WHI showed a risk in the first year of blood clots, but this risk has not been replicated with topical formulations. The USPSTF guideline is that women with any previous cardiovascular disease should not take HRT, and women without such disease may but not for heart health reasons. In reaching this guideline, all evidence other than the WHI data was expressly taken out of consideration.

In general, there is consensus that starting HRT more than 10 years after menopause is not beneficial and may be harmful. On just about everything else, well, see above.
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