Estrogen Therapy For Menopause

Abstract

The medical management of menopause continues to be a topic of controversy. Although many of the benefits of estrogen therapy have been well established (treatment of estrogendeficiency symptoms, prevention of osteoporosis, and prevention of coronary heart disease), the potential risks of breast cancer are of great concern. Although many postmenopausal women are candidates for hormone replacement therapy (HRT), many choose not to take it because of fear of breast cancer or concerns about potential side effects and continued menstrual bleeding. Therefore, making choices about potential therapies after menopause can be a difficult one for both women and their health care providers. An important principle of HRT is the notion of short-term versus long-term use, as the goals of both therapy and riskbenefit profiles are different. Although most perimenopausal and postmenopausal women are candidates for short-term HRT (with the exception of those with a history of breast cancer), no general consensus is found regarding who should or should not receive long-term HRT. Other new areas of clinical investigation in the field of menopause and HRT include the possible impact of estrogen on cognitive function, the role of exogenous androgen replacement for libido, and the role of a new class of drugs known as "selective estrogen receptor modulators" (SERMs). Given this rapidly changing field, it is likely that the medical management of menopause will continue to evolve in the coming years.