HORMONE AND NONHORMONE THERAPY FOR THE MAINTENANCE OF POSTMENOPAUSAL HEALTH - THE NEED FOR RANDOMIZED CONTROLLED TRIALS OF ESTROGEN AND RALOXIFENE

Multiple health benefits have been postulated for the long-term use of hormone therapy in postmenopausal women, most notably for prevention of osteoporotic fractures and coronary heart disease, as well as sever al risks, including cancer of the breast and uterus and venous thrombo embolism. Cardiovascular disease is the most common cause of death amo ng postmenopausal women. If real, the reduction in risk of coronary he art disease by hormone use suggested by observational studies would li kely outweigh the risks. The decision to initiate and maintain hormone therapy is complicated by uncertainties about estrogen's true benefit s and risks. Raloxifene, a selective estrogen receptor modulator (SERM ), appears to have many of the benefits of estrogen without the cancer risks. It is not known if SERMs can provide significant cardiovascula r protection. This article reviews the relation of use of postmenopaus al hormones and raloxifene to women's health and addresses the need fo r large randomized trials to quantify the effect of both postmenopausa l estrogen and raloxifene on cardiovascular health.