Stakes and perspectives of the treament for menopause

Hormone replacement therapy (HRT) represents a major break-through for post -menopausal women : better quality of life and protection against osteoporo sis are widely acknowledged benefits, while cardiovascular protection and p revention of dementia are appealling questions to which current large clini cal trials should provide answers in the future. The perspectives imply: (1 ) optimization of HRT, in terms of the drugs, the route of administration, and adjustable dosage forms; (2) alternatives are essential in case of cont raindications to HRT, Neither androgens, nor phytoestrogens are acceptable alternatives to HRT. Selective estrogen receptor modulators (SERMs) are the most original and promising agents today. Raloxifen has been the most, wid ely studied, yet little is known about its potential adverse effects, and i t seems more appropriate for osteoporosis prevention than a true HRT altern ative. Lastly, the social and economic aspects also need to be dealt with: compliance with HRT must be improved in, the future, in particular by offer ing constantly up-dated continuous medical education, and by optimizing the cost/efficacy ratio of HRT in order to make it readily available.