Abstract

PIP: A consensus development conference held at the National Institutes of Health on September 13-14, 1979 addressed the issue of estrogen treatment for postmenopausal women. Conference participants included research scientists, physicians, and consumers. Conclusions reached by the conference participants were: 1) estrogens are more effective than placebos in reducing vasomotor symptoms associated with menopause; 2) therapy should be undertaken only if the patient considers the symptoms to be severe enough to warrant treatment, and the smallest dose possible should be administered; 3) estrogens are effective in treating atrophy of the vaginal epithelium, but the use of estrogen creams to treat localized vaginal areas needs further study; 4) estrogens should not be used to treat primary psychological problems; 5) insufficient data is available for determining whether estrogen therapy decreases the risk of fracture associated with osteoporosis; 6) recent investigations indicate estrogen therapy reduces bone loss, but it is not known if the effect is permanant; 7) estrogen therapy appears to neither increase nor decrease the risk of thromboembolism, stroke, or heart disease; 8) estrogen therapy is associated with an increased risk of endometrial cancer but primarily with low grade endometrial cancers; 9) cystic hyperplasia is associated with unopposed estrogen therapy; 10) yearly endometrial samples should be obtained and checked for endometrial changes for all patients receiving estrogen therapy; 11) evidence supporting an association between estrogen therapy and breast cancer is indecisive; and 12) estrogen therapy is associated with an increased risk of gallbladder disease. In general, many areas need further study and patients themselves will have to assess whether symptom relief is of sufficent importance to them to warrant the acceptance of the possible risks involved in the therapy.