Menopause and hormone replacement therapy.

Introduction. - Considered until recently as a biological fate, menopause h as evolved within a decade into a major public health issue at stake. Such an evolution results from various factors that deserve an exhaustive critic al approach because the situation is much more complex than it appears to b e at first analysis. Current knowledge and key points. - 1) Ninety-fiver percent of the availabl e epidemiological information relies on observation or cohort studies, such as case-control studies that do not allow any certitude in regard to thera py. 2) Chronic estrogen deficiency probably plays a pathogenic role in vari ous symptoms or pathological conditions that are associated to menopause. 3 ) However, behind the paradigm of menopause, there is a whole psychosocial construct that classifies what remains a physiological condition within maj or risk factors, just as for the most serious chronic diseases. 4) Indeed, menopause cannot be considered as a well-characterized disease, and hormone replacement therapy is undeniably a complex therapeutic intervention that requires proper prescription and careful evaluation of the benefit:risk rat io. 5) While such a treatment is now considered as the gold standard for th e prevention of post-menopausal osteoporosis, this does not hold true regar ding cardiovascular diseases. 6) Although hormone replacement therapy may l ead to the relief of Various symptoms associated with menopause, it may als o result in side-effects that extreme medication cannot prevent, especially since some of them are not fully known, particularly in the case of either long-term or very long-term treatments. Future prospects and projects. - A more rigorous evaluation of side-effects of hormone replacement therapy in the framework of long-term controlled tr ials is therefore clearly required. The indications of such a treatment sho uld only rely on objective data and not on questionable studies or impressi ons at clinical examination. (C) 2000 Editions scientifiques et medicales E lsevier SAS.