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The Controversy of Use of Hormonal Replacement Therapy (HRT) in Post-Menopausal Women; Preliminary Study in Indonesia

Conference: International Conference Pharmacy on Research and Practice

ABSTRACT The number of postmenopausal women in the world in 2020 according to the World Health Organization is expected to reach 1.2 billion, while in Indonesia, according to the Central Beraeu of Statistic (CBS) number of postmenopausal women in 2025 will reach 60 million people. In general, postmenopausal women will have experience a variety of complaints such as hot flush, osteoporosis, sleep disorders, obesity, anxiety, urogenital disorders, dementia and sensory impairments. Postmenopausal women will be at risk of suffering from diabetes, coronary heart disease, osteoporosis, dementia, and cancer. Various complaints and interference are due to declining ovarian hormones including estrogen and progesterone. This situation is the reason why about 1 million postmenopausal women in the UK do hormonal replacement therapy (HRT). Reports from various overseas researchs show that HRT is useful to reduce short-term symptoms of menopause, prevent osteoporosis, and decrease the incidence of colorectal cancer, but in the long run more than 4 years should be vigilance and caution considering the negative effects such as the risk of breast cancer, uterus cancer, thromboembolism, stroke, hypertension, and biliary abnormalities. Controversy over the use of HRT is increasingly becoming debate after reports of the Women Health Initiative (WHI) in 2002 which reported an increased risk of breast cancer 1.2 time. Actually, the risk is still small compared to the risk of breast cancer because of smoking. It is therefore necessary to study the use of HRT in postmenopausal women, especially in Indonesia. Based on a qualitative study of the controversial use of HRT in menopause women among clinicians in particular medical specialist in internal medicine and a specialist gynecologist and obstetrician can be seen that clinicians tend to prefer a combination of estrogen and progesterone than estrogen singles. We found the controversy of usage HRT among clinicians into three opinion consisting pesimistic opinion, natural opinion, and conditional opinion although basically only two alternative reject or accept to use the HRT. Clinicians have more concerned about the negative effects of the risk of breast cancer in postmenopausal women who use HRT. This is due to the track record of patient incomplete, incomplete examination method to monitor the negative effects of the use of HRT, HRT dose appropriate and benefit/safety of HRT remain uncertain, and inconsistent outcomes of various research reports as well as the conflict between basic science facts role of estrogen, clinical benefit and observations epidemiological studies.