Project guidelines for postmenopausal hormone replacement therapy

Hormonal therapy: estrogen therapy (ET) and estrogen-progestogen therapy (EPT), in postmenopausal women has to be individualized, taking into account benefits and potential risks, as part of a global strategy of health management. The randomized controlled clinical trials of the past decade have changed the general thinking in the field, leading to the mostly accepted theory of initiating hormone therapy in symptomatic women, near the menopause, in the so-called "window of opportunity", when estrogens may be cardioprotective because the vascular endothelium is still intact, and may even be beneficial for some cognitive domains. The second point suggested is the use of lower doses of hormone therapy for the shortest period of time, necessarily to solve the problem. The main indications for initiating hormone therapy are: moderate to severe vasomotor symptoms, genitourinary complaints, and prevention of postmenopausal osteoporosis. In all women with an intact uterus who are using estrogen therapy, an adequate progestogen has to be added in a continuous or sequential regimen, in order to prevent endometriurn carcinoma. The use of hormonal menopausal therapy for about five years does not seem to be associated with significant risks, such as breast cancer, cardiovascular risk, if therapy is initiated in the late menopausal transition and early postmenopausal, symptomatic women. Venous thromboembolism and stroke remain the main serious risks of taking hormone therapy. There are no data at present to support the indication of hormone therapy in older women in order to prevent chronic medical conditions, like coronary heart disease or dementia, as secondary prevention.