Standard and low-dose hormone therapy for postmenopausal women--focus on the breast.
Menopause occurs naturally when the ovary ceases folliculogenesis, or artificially by surgical and/or medical ablation of the ovarian function. Menopause is a hypoestrogenic state, which may adversely affect estrogen target tissues, such as the brain, skeleton and skin, as well as the cardiovascular and genitourinary systems, with resultant frequency and severity of climacteric symptoms. The climacteric symptoms, however, vary significantly among women. For decades, hormone therapy (HT) has been the mainstay and is considered the most effective for managing menopausal symptoms. The prolonged use of either single estrogen therapy or a combination therapy of estrogen and progestogen (EPT) might be associated with a slightly increased risk of breast cancer and many resultant adverse events, such as coronary heart disease, stroke and venous thromboembolism. Perhaps because the clear benefits are limited to these end points of HT in treating menopausal women, the relatively significant adverse event profiles of these women may not be enough to trigger primary care physicians to be more aggressive than they have been to date in treating climacteric symptoms of postmenopausal women. However, severe climacteric symptoms really disturb the woman's life. Some epidemiologic studies have shown that the increased risk for breast cancer after 5 years of combined EPT is similar in magnitude to other lifestyle variables, such as 10-year delayed menopause, fewer pregnancies and reduced breastfeeding, postmenopausal obesity, excessive alcohol or cigarette use, and lack of regular exercise. Furthermore, elevated serum concentrations of either endogenous or exogenous (replaced by HT) sex hormone in either pre- or postmenopausal women are associated with an increased risk of breast cancer. Finally, the increased breast cancer risk diminishes soon after discontinuing hormones, and largely disappears by 5 years after cessation. Taken together, low-dose conventional HT can be used with symptomatic menopausal women, but is worthy of further evaluation because we found the following potential benefits, including (i) low-dose oral EPT appears to be effective for the alleviation of climacteric symptoms; (ii) it has a good tolerability profile with a low incidence of the most common and problematic side effects, such as breast tenderness and an increased mammographic density. Altogether, when compared with the standard dose HT, physicians may prefer to use low-dose HT initially in managing the climacteric symptoms of postmenopausal women. Time will prove.
Wang
Peng-Hui
PH
Department of Obstetrics and Gynecology, Taipei Veteran General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan. phwang@vghtpe.gov.tw <phwang@vghtpe.gov.tw>
Horng
Huann-Cheng
HC
Cheng
Ming-Huei
MH
Chao
Hsiang-Tai
HT
Chao
Kuan-Chong
KC
D001941:Breast Diseases / Q000139:chemically induced; D002979:Climacteric / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D020249:Hormone Replacement Therapy; D019584:Hot Flashes / Q000188:drug therapy; D006801:Humans; D008327:Mammography; D010146:Pain / Q000139:chemically induced; D017698:Postmenopause / Q000187:drug effects*; D018570:Risk Assessment; D014666:Vasomotor System / Q000187:drug effects