Major Issues Regarding Estrogen Replacement Therapy in Postmenopausal Women

Abstract

The menopause marks a critical time in a woman's life when she needs to consider the advisability of estrogen replacement therapy. The issue is controversial because of the need to balance clear-cut benefits of estrogen therapy against certain risks. The benefits of estrogen replacement therapy include protection against both cardiovascular disease and the development of osteoporosis. Women who do take estrogen replacement therapy show a markedly reduced risk for developing complications of atherosclerotic cardiovascular disease as well as a reduced risk of osteoporotic fractures. Estrogen replacement therapy is also beneficial to women who suffer with the vasomotor instability of the menopause (hot flashes), and is believed to improve skin quality, mood and mental function. In contrast to these beneficial effects, estrogen replacement therapy is associated with certain risks such as endometrial carcinoma. The increased incidence of endometrial cancer is completely negated by cycling estrogen with a progestational agent. An area of great controversy is breast cancer. The extensive literature on this subject is still inconclusive, but would appear to place women at a slight but significantly increased risk. In addition to reviewing the benefits and risks of estrogen replacement therapy, this article considers the need to tailor these considerations to the individual patient. If one takes into account, in a given individual, the risks of cardiovascular disease, osteoporosis, endometrial cancer and breast cancer, it is possible to approach the subject rationally and to give the postmenopausal woman sound advice as to what is best for her.