Postmenopausal Oestrogen Replacement Therapy: An Appraisal of Risks and Benefits

Conclusion

At the present time postmenopausal oestrogen replacement therapy is controversial. Numerous reports of an increased risk of endometrial carcinoma in patients receiving unopposed oestr ogen has led many women and physicians to abandon their use. However, recent data, particularly with regard to prevention of postmenopausal osteoporotic-related fractures, and the elimination of the added risk of endometrial neoplasia by added progestagens, suggest the need for a more careful examination of the risk/benefit ratio. Postmenopausal oestrogen replacement therapy should not be withheld from the patient with troublesome vasomotor symptoms, symptomatic genitourinary atrophic changes or to prevent osteoporosis in patients at risk. Oestrogens are indicated in the prematurely oestrogen-deficient women to prevent premature atherosclerotic cardiovascular disease. Oestrogen should be given cyclically in all women and for those women with a uterus, a progestagen should be added for the last 10 days of each cycle. In all situations the woman should participate in the decision to use oestrogen, and must understand the indications for its use and expected duration of treatment. With continued medical surveillance and prompt investigation of any abnormal vaginal bleeding the risks of oestrogen administration are outweighed by the benefits in those patients in whom replacement therapy is needed.