[Hormonal replacement therapy. Benefits and risks].
A woman lives an average of between 25 to 30 years since the beginning of menopause. This period of life is characterized for the appearance of chronic diseases. Estrogens are effective in controlling vasomotor symptoms and also over the loss of bone mineral density, therefore lowering the risk of fractures in about 25-30%. The use of unopposed estrogens (without progesterone) raises 8 to 10 times the risk of endometrial and 2 to 3 times the risk of deep venous thrombosis as well. Until now, no raise was seen in breast cancer in short treatments (less than 5 years) especially if they are not opposed with progesterone. The recent publication of the surprising data of the trial Women's Health Initiative demonstrates a significative but small increase in the risk of breast cancer associated with the use of combined estrogen/progestin therapy proportional to the duration of the treatment. The reduction of the plasmatic levels of low density lipoproteins associated with the use of Hormonal Replacement Therapy (HRT), has not been linked to evident cardiovascular protection. There is a higher cardiovascular risk with the use of HRT in the first year of the treatment. No clear benefit of HRT has been associated to treatment of Alzheimer disease, and is still under investigation its role in the prevention of the disease.


CONCLUSIONS
1) A careful analysis of advantages and risks of HRT must be done before its use. 2) The treatment must be instituted on an individual basis and should be discussed with each patient.
Unidad de Internación de Obstetricia del Hospital Juan A. Fernández, Buenos Aires, Argentina.
Alicia M
AM
Lapidus
D000368:Aged; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D010024:Osteoporosis / Q000517:prevention & control; D012307:Risk Factors