Menopause and hormone replacement therapy

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The recent literature has evaluated a number of regimens for hormone replacement therapy comprised of various estrogens and progestins in different sequences. Outcomes of interest include effects on bleeding pattern, lipid profile, cardiovascular disease, breast cancer, osteoporosis, and psychologic function. Cyclic administration of a progestin (10 to 14 days of the month) with either cyclic or continuous estrogen (days 1 through 25 or daily) has been the most widely used and studied of the treatment regimens. Other methods can be used, with the understanding that long-term data on safety and efficacy are scant. Cardiovascular benefits have been reported in many studies. Although it is possible that benefits have been overestimated because of selection bias, even a small benefit would have a significant effect in terms of the large number of women dying from cardiovascular disease. Stabilization of bone density by hormone replacement therapy has been well documented. Less-uniform results are reported in the area of psychologic function; some women experience benefits, but some do not. Some subjects may even feel worse with hormone replacement therapy. The relationship between hormone replacement therapy and breast cancer remains a controversial issue. Despite several meta-analyses, there is no consensus in the medical community on this issue. Individualizing the use of hormone replacement therapy while promoting a healthy lifestyle will maximize benefits for the menopausal woman.

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