[Principles of hormone substitution in the postmenopause period]

Abstract

Substitution of hormones does not only serve to alleviate vasomotor and psychic imbalance but mainly to prevent osteoporosis and cardiovascular disease. Essential prerequisites are good tolerance, minimal risk, compliance and low cost. Natural estrogens, in contrast to ethinyl estradiol, without effect on the coagulation system when dosed appropriately are preferred. Sequential or continuous addition of progestogens lowers the incidence of endometrial cancer. Derivatives of progesterone appear to be more suited than 19-nortestosterone derivatives because they do not affect the plasma lipid profile significantly and do not jeopardize the estrogen-induced increase in vasoprotective HDL. Dosing of estrogens follows clinical requirements and minimally effective activity against osteoporosis. Progestogens are dosed according to their endometrial activity. According to current experience only long term treatment is successful.