Post Reproductive Health

The risk of breast cancer is moderately elevated in current and recent hormone replacement therapy users, with an approximate 2.3% excess risk per year of use. Some excess risk has also been reported for ovarian cancer in long-term users. Unopposed oestrogens are strongly related to endometrial cancer risk, but cyclic progestogen addition appears to reduce this side effect, possibly further increasing the risk of breast cancer. There is a moderate inverse association between colorectal cancer and hormone replacement therapy. Most potential favourable and adverse effects of hormone replacement therapy on cancer risk are restricted to current users. Selective oestrogen receptor modulators may offer advantages in reducing breast cancer risk. Regular aspirin use and high levels of physical activity induce a moderate reduction of risk for colorectal, and possibly for breast, ovarian and endometrial cancer. Overweight and obesity are strongly related to gallbladder, endometrial and breast cancer, and appear to be also related to colorectal, renal, pancreatic and ovarian cancer.

Osteoporosis is a major public health problem because of its association with fractures. Prevention of osteoporosis is of utmost importance in reducing the health and human costs related to the disease. Bone mass in adult life is determined partly by the peak bone mass accrued as a young adult, and partly by the subsequent rate of bone loss. Understanding the determinants of premenopausal bone mineral status is important in order to develop a prevention strategy. Non-modifiable risk factors are heredity and race/ethnicity. Potentially modifiable are non-genetic host factors such as intrauterine programming, body build, reproductive factors, diseases and drugs, and environmental factors such as diet, exercise and smoking and alcohol.

There is a decline in respiratory function with age that is independent of sex. However, women present with respiratory illness twice as commonly as men. This review will examine the effects of ovarian steroids on normal and abnormal respiratory function. The effects of age, menopausal status and hormone replacement therapy on specific symptoms such as dyspnoea, cough, airway hyper-responsiveness and snoring will be examined. Studies examining the effects of menopausal status and hormone replacement on the respiratory system are limited. While hormone replacement therapy may predispose to asthma, its use in women with the disease does not have an adverse effect.

Dehydroepiandrosterone (DHEA) is the major steroid product of the adrenal cortex yet it still remains controversial as to whether it is a true hormone. The regulation of DHEA is poorly understood and no specific receptor has been characterised. Despite this, the use of DHEA as an anti-ageing treatment outside medical supervision has been increasing over recent years as people attempt to restore the levels seen in early adulthood. DHEA has also been advocated as a possible treatment for menopause, with some practitioners even suggesting it as an alternative to standard hormone replacement therapy. The proponents of DHEA replacement therapy claim positive actions on cardiovascular and immune systems, together with beneficial effects on bone metabolism and mood. In fact, there have been very few well planned randomised, placebo-controlled, double-blind clinical trials and there is very little clinical evidence to support the hope invested in this hormone. Further clinical trials are urgently needed.