Cessation of cyclic release of steroid hormones, estrogen and
progesterone in women is associated with a number of
menopausal complications. Hot flashes, night sweats,
vasomotor symptoms, and vaginal dryness are the most
disturbing symptoms to the peri-menopausal women.
Postmenopausal women become subject to osteoporosis and risk
of coronary heart disease. Hormone replacement therapy
effectively reduces the vasomotor sysmptoms. Many studies also
showed that the postmenopausal steroid hormone therapy can
prevent the development of osteoporosis. Some studies
indicated that the estrogen-replacement therapy reduces the
risk of developing or dying of coronary heart disease by 35-
50 percent. Due to the beneficial effects of steroid
hormones, the use of estrogen to prevent the menopausal
symptoms became popular in 1960s. Several studies, however,
showed that estrogen replacement therapy (ERT) for five or
more years leads to 2-20% increase in the risk of developing
endometrial cancer. Such findings led to a decline in the
use of this type of treatment in 1975-1980. Some studies
have indicated that the ERT is associated with an increased
risk of developing breast cancer. However, this is an
unsettled issue since many other studies have failed to show
such association. In addition, since the mid to late 1980s,
the concern over the use of estrogen alone, led to the
introduction of combined progestin-estrogen (PERT)
therapy. Some prescribe to the view that addition of progestin
reduces various risks associated with the treatment with
estrogen. However, some studies indicate that both ERT and
PERT beyond 5 years are associated with increased risk of
breast cancer. In view of such findings, some clinicians do
not advocate the use of hormone replacement therapy as the
first line approach in prevention of coronary heart disease
and even osteopororsis. In view of these uncertainties,
additional studies are ongoing to provide a set of guidelines
in the use of steroid hormones after menopause. It is clear
the such therapies lead to a better quality of life by
reducing the vasomotor symptoms and the vaginal atrophy
associated with the estrogen deficiency. However, whether
they prolong life and reduce the mortality in postmenopausal
women, require further studies. Thus, at the present time,
the ultimate decision regarding such treatments should be
individualized and should be guided by both the views of the
clinician involved as well as the fears and discomforts of
the given patient.
Cessation of cyclic release of steroid hormones, estrogen and
progesterone in women is associated with a number of
menopausal complications. Hot flashes, night sweats,
vasomotor symptoms, and vaginal dryness are the most
disturbing symptoms to the peri-menopausal women.
Postmenopausal women become subject to osteoporosis and risk
of coronary heart disease. Hormone replacement therapy
effectively reduces the vasomotor sysmptoms. Many studies also
showed that the postmenopausal steroid hormone therapy can
prevent the development of osteoporosis. Some studies
indicated that the estrogen-replacement therapy reduces the
risk of developing or dying of coronary heart disease by 35-
50 percent. Due to the beneficial effects of steroid
hormones, the use of estrogen to prevent the menopausal
symptoms became popular in 1960s. Several studies, however,
showed that estrogen replacement therapy (ERT) for five or
more years leads to 2-20% increase in the risk of developing
endometrial cancer. Such findings led to a decline in the
use of this type of treatment in 1975-1980. Some studies
have indicated that the ERT is associated with an increased
risk of developing breast cancer. However, this is an
unsettled issue since many other studies have failed to show
such association. In addition, since the mid to late 1980s,
the concern over the use of estrogen alone, led to the
introduction of combined progestin-estrogen (PERT)
therapy. Some prescribe to the view that addition of progestin
reduces various risks associated with the treatment with
estrogen. However, some studies indicate that both ERT and
PERT beyond 5 years are associated with increased risk of
breast cancer. In view of such findings, some clinicians do
not advocate the use of hormone replacement therapy as the
first line approach in prevention of coronary heart disease
and even osteopororsis. In view of these uncertainties,
additional studies are ongoing to provide a set of guidelines
in the use of steroid hormones after menopause. It is clear
the such therapies lead to a better quality of life by
reducing the vasomotor symptoms and the vaginal atrophy
associated with the estrogen deficiency. However, whether
they prolong life and reduce the mortality in postmenopausal
women, require further studies. Thus, at the present time,
the ultimate decision regarding such treatments should be
individualized and should be guided by both the views of the
clinician involved as well as the fears and discomforts of
the given patient.
