last updated 20-12-2024

Hormone replacement therapy

Hormone replacement therapy

One of the most complex health care decisions facing women is whether or not to use postmenopausal hormone therapy.

Estrogens decrease the menopausal symptoms such as flushing, transpiration, vaginal atrophy etc. This review describes the effect of HRT versus the placebo effect.

Progestagens (dydrogesterone and progesterone) should be added to the therapy because they prevent estrogen-induced hyperplasia of the endometrium. Combination preparations are available on the market: estradiol/dydrogesterone. Therapy of choice is now a combination of estrogen and progestagen in the lowest possible dosing for a short period of time (3-6 months).

Long-term use of estrogen supplements increases the risk of carcinomas of the endometrium, mamma, and ovary and thrombo-embolism. Long-term estrogen supply is no longer treatment of choice for post menopausal osteoporosis.

An alternative to the hormonal therapy is clonidine. This drug is not as effective as hormones, but can diminish flushing and transpiration. The spectrum of side effects is completely different. See also clonidine in the cardiology chapter.

In order to decrease the systemic estrogen effects, estrogens can be applied locally to decrease urogenital complaints. Estradiol administered as vaginal tablet or estriol applied as cream or ovule are prescribed for postmenopausal women with atrophic vaginitis. It is clear, that these local applications do not have beneficial effects on the vasomotoric symptoms.

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In post-menopausal women hormone replacement therapy increases the risk of … 

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