The first World Summit on Menopause-Related Diseases (March 2008) was held in Zurich, Switzerland. The conference summarized today’s consensus on postmenopausal hormone therapy versus previous misconceptions about it. Hormone replacement therapy in early menopause: Rational scientific evidence versus conventional wisdom: Quality of life: The fundamental aim of menopausal management is to enable women to enjoy a good quality of life, which is as important as disease prevention and treatment. HRT is the preferred and best way to improve quality of life and sexual function in postmenopausal women with clinical symptoms, and there is no controversy in this regard. Cardiovascular system: Conventional wisdom: HRT increases the risk of CHD of coronary heart disease throughout the late postmenopausal period. Current evidence: HRT does not increase the risk of developing CHD in healthy women aged 50-59 years and may even reduce the risk in this age group. Conventional wisdom: HRT can increase the incidence of coronary heart disease events in all women during the first 1-2 years of HRT treatment. Current evidence: No increase in the occurrence of coronary heart disease was observed in patients during the first 2 years of HRT performed early after menopause. Two WHI clinical trials have shown that the number of CHD cases decreases with the duration of HRT treatment. Conventional wisdom: Women treated with HRT have a significantly increased risk of stroke. Current evidence: It is unclear whether there is a statistically significant increase in the incidence of ischemic stroke in healthy women aged 50-59 years treated with standard HRT. The low prevalence of the disease in this age group would also make this risk highly unlikely. Conventional wisdom: Increased risk of venous thromboembolism during HRT treatment. Current evidence: The risk of venous thromboembolism is approximately twofold higher in patients taking standard oral doses of HRT in early menopause, but this remains a rare case because of the extremely low incidence of the disease in healthy women younger than 60 years of age. The risk of venous thromboembolism is likely to be lower with transdermal administration than with oral estrogen therapy. Breast problems: Conventional wisdom: All HRT treatments increase the risk of breast cancer in the short term. Current evidence: The WHI study population showed a small increase in the risk of breast cancer after 5 years of combined estrogen and progestin use, about eight cases per 10,000 women per year, with no increase in the risk of breast cancer in first-time hormone users. no increase in the risk of breast cancer after up to 7 years of treatment was seen in the WHI study population on estrogen alone. Furthermore, a significant reduction in the risk of invasive breast cancer occurred in women treated with estrogen for the first time. In the observational study, a small increase in risk was found only with long-term estrogen therapy. Conventional wisdom: A decrease in breast cancer incidence was reported in the United States following the publication of data from the WHI, which confirmed that HRT can cause cancer. Current Evidence: The decline in breast cancer incidence in the United States began before the release of the WHI data and is due in part to the inconsistency of patient screening. According to the Million Women Study, there has been no decline in breast cancer patients registered in the United Kingdom, and no decline in Norway, Canada, the Netherlands, or other countries with stable screening systems. Conventional wisdom: HRT can lead to increased breast density on mammography, and increased breast density correlates with increased risk of breast cancer. Current evidence: Elevated basal breast density is a risk factor for the development of breast cancer. Depending on the treatment regimen used, elevated breast density occurs in 50% of menopausal women treated with combined estrogen + progestin. The mean value of breast density elevation under standard treatment dose conditions was 10%. Estrogen alone causes a smaller effect. There are no data to support a direct correlation between increased breast density due to HRT and progression to breast cancer. Bone Conventional wisdom: HRT should not be used for bone protection because of the adverse safety profile. Official recommendations from health authorities (EMEA, FDA) limit the use of HRT to a second-line alternative. HRT will only be considered if other treatments are ineffective, contraindicated or poorly tolerated, or for women with extremely pronounced symptoms. Current evidence: HRT is safe and economical for women aged 50-59 years. Overall, HRT is effective in preventing all osteoporosis-related fractures, even in patients with a low risk of fracture. Conventional wisdom: HRT is not as effective as other products (diphosphonates) in reducing the risk of fracture. Current evidence: Although there is no direct comparison between HRT and diphosphonates for fracture reduction, there is also no evidence that diphosphonates or other bone resorption inhibitor therapy is superior to HRT. Cognitive ability: Conventional wisdom: The menopausal transition is associated with cognitive decline. Current evidence: There is no evidence of significant cognitive decline during the menopausal transition. However, many women experience cognitive difficulties with vasodilatory symptoms, sleep disturbances, and mood changes. Conventional wisdom: HRT can increase the risk of cognitive/memory impairment and dementia at any age. Current evidence: No cognitive benefit was found in women who started HRT treatment late in menopause (after age 65). Observational studies have found a reduced risk of developing dementia in patients treated with hormones, usually seen in women treated with estrogen early in the menopausal transition. The cognitive benefits of estrogen therapy for patients depend on the age at which treatment is initiated. Conventional wisdom: Progesterone and estrogen have conflicting effects in the brain. Current evidence: limited data on the effects of progestin use on top of estrogen in early postmenopause. CONCLUSIONS: The prevalence of menopausal symptoms, and of menopausal or HRT-related disorders, varies widely across the world, as does the importance of these symptoms and disorders in health care. In addition, local cultural and social factors can have a profound impact, all of which can shape perceptions and decisions about menopausal treatment and hormone use. Each regional/national menopause society should adapt the overall framework to its own situation and needs. Note: The target population for initiation of HRT is usually women who have reached the age of 55. HRT is safe for use in healthy women in the early postmenopausal period. As with all treatments, HRT needs to be used correctly, but crucially, HR should be chosen by women with symptoms in the early postmenopausal period.