[Controversies surrounding on hormone replacement therapy during menopause]

Abstract

During the menopausal transition and the early postmenopausal stage diverse symptoms may appear, but only hot flashes and night sweats are inequivocally related to the hormonal changes, constituting the main indication for the use of systemic hormone therapy. In the absence of vasomotor symptoms, the prescription of hormone therapy to either ameliorate psychologic disorders or improve quality of life still is a controversial issue. In order to improve treatment individualization, more information regarding the hormonal effects on peri- and postmenopausal women suffering from chronic diseases such as high blood pressure, obesity and diabetes, is needed. The use of low doses of estrogens and progestins is highly desirable, but the lack of knowledge and availability of appropriate formulations seems to hinder it. Even though it has been demonstrated that hormone therapy does not prevent cardiovascular diseases in postmenopausal women, there are some products that are improperly promoted for this purpose. The benefits of hormone therapy on bone mineral density and osteoporosis prevention are unquestionable. However, because of its potentially deleterious effects on breast tissue its long-term use for bone protection has been restricted. Several studies to assess risks and benefits of low-dose formulations are ongoing. It is expected that better results will be obtained with these new formulations.