Recently I was asked about hormone replacement therapy (HRT) for a 72 year old woman who underwent a breast biopsy 6 months ago revealing atypical ductal hyperplasia and lobular hyperplasia. She is a "vasculopath" - severe coronary, peripheral vascular and cerebrovascular disease, and her cardiologist and gynecologist are questioning whether there might be a cardiovascular benefit from estrogen replacement therapy. My questions are:
1. Is there any cardiovascular benefit from HRT in a 72 year old woman? I thought that one recent study showed that after 10 years, cardiovascular mortality was the same for women who received HRT and those who did not.
2. Is the presence of atypical hyperplasia a contraindication to HRT?
3. Would anyone recommend one of the new "designer" estrogens, such as Raloxifene, which may have a lower breast cancer risk?