Perspectives in hormone replacement therapy

Estrogens have been convincingly shown to be highly effective in preventing and reversing menopause-related conditions, such as hot flushes, urogenita l complaints, and postmenopausal bone loss. Observational studies report th at long-term, estrogen-containing, postmenopausal hormone replacement thera py (HRT) leads to a substantial reduction in hip fractures, myocardial infa rction, and possibly colonic cancer, with important consequences for health and quality of life. Estrogen replacement may postpone the onset of Alzhei mer's disease and extend life. While many of these effects are biologically plausible, with a variety of cellular mechanisms being involved, only ongo ing and future large-scale randomized clinical trials can and should define the effects of HRT more precisely. Long-term compliance is a key issue for long-term benefits, and offering women a choice of administration routes a nd regimens can only be beneficial in this respect. Pills, patches, gels, a nd implants are all widely prescribed. Intravaginal or intranasal forms of administration, which are very easy to use and adaptable on an individual l evel, are among the new options which could improve long-term continuation of HRT use. Fear of breast cancer and recurrence of vaginal bleeding are re al concerns for many women considering HRT. This has led to research into l ower-dose, estrogen-containing regimens, into continuous combined regimens, and into the potential of estrogen receptor alpha or beta binding molecule s that may help to prevent such problems from arising. The prospects for sa fe and effective postmenopausal HRT with either estrogens or estrogen-like drugs are very promising when these drugs are used in a patient-tailored, r isk profile-based manner. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.