The hormone continuum is a treatment strategy that advocates maintaining ho
rmone continuity, from the reproductive years into menopause and beyond. Th
is entails the use first of oral contraceptives (OCs), which confer well-kn
own health benefits-especially reductions in ovarian and endometrial cancer
s-besides effective contraception, and later, hormone replacement therapy (
HRT), which provides relief of perimenopausal and menopausal symptoms and p
rotects older women from (a) decreasing bone mineral density; (b) cardiovas
cular disease, according to several studies; and (c) Alzheimer's disease, a
s suggested by a number of studies.
In perimenopause, use of OCs declines by about one-half, and then by a furt
her four-fifths up to menopause. This is unfortunate, because in these late
r reproductive years women are subject to unintended pregnancy, which in 65
% of cases is terminated by abortion. Furthermore, women are thereby depriv
ed also of alleviation of dysmenorrhea and even vasomotor symptoms that oft
en characterize the perimenopause.
After menopause is well established, a "seamless" transition to HRT can be
made, often with the same progestin that was contained in the OC.
This paper discusses risks as well as benefits of hormone therapy, especial
ly of HRT, with an emphasis on patient counseling and individualizing of th
erapy.