The use of
estrogen replacement therapy in postmenopausal women is under close scrutiny. The indications and side effects of replacement
therapy are reviewed, and recommendations regarding its use are made.
Hot flashes,
atrophy of the vaginal epithelium, and prevention of
osteoporosis have been established as indications for
estrogen replacement therapy. Prevention of
cardiovascular disease, aging changes of skin, and the occurrence of
mental illness have also been suggested as indications, but beneficial effects of
estrogen replacement therapy for these problems have not been clearly established. Studies have shown that side effects of
estrogen replacement therapy include
endometrial cancer,
hypertension,
gallbladder disease, and
angina pectoris.
Breast cancer may also be a risk factor, but a consensus of opinion has not been established.
Pulmonary embolism, cerebral vascular accident, or
myocardial infarction has not been associated with
estrogen replacement therapy. The use of
progesterone with
estrogen replacement therapy has been shown to reduce the occurrence rate of
endometrial carcinoma, but it does not prevent all the actions of
estrogen.
Oral administration of
estrogen is the preferred route despite misgivings about portal absorption and liver metabolism. Further studies must examine this question. Various agents have been shown to be effective in treating some climacteric symptoms. These include
progesterone for
hot flashes and
calcium for the prevention of
osteoporosis. Other agents may also be effective but have not been tested critically.