LONG-TERM HORMONE REPLACEMENT TREATMENT IN MENOPAUSE - NEW CHOICES, OLD APPREHENSIONS, RECENT FINDINGS

In recent years there has been an increase in the use of parenteral oe stradiol as an alternative to the conventional oral preparations used in hormone replacement treatment (HRT) in menopause, such as conjugate d equine oestrogens (CEE). The latter have been subject in the past to apprehensions, partly due to misunderstanding and oversimplification but also in relation to problems that have arisen during the history o f HRT, for example the increase in endometrial cancer risk deriving fr om the use of non-progestogen-opposed treatment. However, confidence i n long-term HRT comes from the epidemiological findings, which refer m ainly to the use of oral CEE unopposed by progestogen: a reduced risk of osteoporotic fractures and of cardiovascular disease, and a very li mited risk of breast cancer. Oral oestrogens produce marked hepatocell ular effects. These effects are, on the whole, favourable from the poi nt of view of cardiovascular risk. In addition, it cannot be excluded that some hepatocellular effects of oral oestrogen, for example increa sed sex hormone binding globulin levels and reduced circulating insuli n-like growth factor I activity, offer protection to the breast. As pr ogestogen supplementation is needed in non-hysterectomized women, prio rity should be given to preparations, such as progesterone or dydroges terone, that feature good endometrial activity without opposing oestro gen hepatocellular effects.