CONTROVERSIES SURROUNDING ESTROGEN USE IN POSTMENOPAUSAL WOMEN

OBJECTIVES: To provide an overview of controversies regarding the use of estrogen in postmenopausal women. DATA SOURCES: A MEDLINE search wa s conducted to identify pertinent literature published since 1990. Rec ently published textbooks devoted to the subjects of menopause and wom en's health were also reviewed, particularly their bibliographies. The bibliographies of selected review articles were also reviewed. STUDY SELECTION: Due to the vast amount of literature, only the most relevan t published studies were reviewed. Review articles and book chapters a uthored by researchers of international reputation were also reviewed. DATA EXTRACTION: Identified studies from the primary literature and s elected reviews were carefully reviewed. Information regarding the use of estrogen in postmenopausal women was extracted. Particular attenti on was given to areas of controversy commonly dealt with in the lay me dia. DATA SYNTHESIS: The number of postmenopausal women in the US will approach 60 million in the next decade. Despite numerous potential be nefits, many women elect to not take estrogen due to fear of cancer or poor understanding of the long-term consequences of menopause and the beneficial effects of estrogen replacement therapy, Many women rely o n the news media for information about hormone therapy and subsequentl y become confused regarding the benefits and risks. Estrogen relieves climacteric symptoms such as hot flushes and symptoms related to genit ourinary tissue atrophy. Outcomes from controlled clinical trials are lacking, but numerous epidemiologic studies document clinically signif icant decreases in cardiovascular disease and osteoporotic morbidity a nd mortality. Unopposed estrogen increases the risk for endometrial ca ncer, but addition of a progestin for at least 10 days per cycle effec tively reduces this risk to that of women who do not take estrogen. Th e association between postmenopausal estrogen use and breast cancer re mains controversial, despite the results of numerous observational stu dies. This uncertainty regarding estrogen replacement and breast cance r risk can actually be reassuring when placed in proper perspective. C ONCLUSIONS: Until some of the controversies surrounding postmenopausal hormone use are resolved, an objective discussion with a knowledgeabl e healthcare professional regarding the potential benefits and risks w ill help women make informed decisions regarding estrogen replacement therapy in the postmenopausal years.