Should we give up hormone treatment in menopause ?

Abstract

Hormone treatment (HT) is an add back regimen of declining hormone or hormones in a postmenopausal woman in order to eliminate unfavorable conditions caused by hormone deficiency, although it does not meet the actual levels secreted from the ovary. Leading indications are hypoestrogenemia and disturbing symptoms related to hypoestrogenic state. Vaginal atrophy, genitourinary symptoms like urinary incontinence, increased risk for osteoporosis and cardiovascular diseases are the other main concerns of HT. On the other hand, postmenopausal women who were treated with HT protocols including estrogen preparations as well as estrogen/ progestogen combinations have been indicated as being exposed to increased risk for breast cancer development. Moreover, HT preparations were demonstrated to be ineffective in protection from cardiovascular diseases and thromboembolic events, in contrast to the prior beliefs. Therefore, today in the light of new data, use of hormone therapy in postmenopausal women seems to lose its relevance. Nevertheless, alternative therapies have been developed to serve for the relief of menopausal disorders. Among them, tibolone, micronized testosterone, dihydroepiandrosterone, selective serotonine noradrenaline re-uptake inhibitors (SNRI), selective estrogen receptor modulators, combined oral contraceptives and fitoestrogens could be preferred. For all that, the most efficacious treatment on menopausal and genitourinary symptoms seems to be HT, yet. Furthermore, HT was indicated to be effective on osteoporosis and reducing postmenopausal bone fractures. HT should be the first choice of treatment in patients with premature ovarian failure and early onset menopause without any familial history of cancer. At the present time, it is advised to use hormone treatment choosing the appropriate preparation with the lowest effective dose with respect to above mentioned indications. If HT was introduced, there are valuable recommendations to keep the duration of therapy less than 5 years.