Hormones for Replacement: A Matter of Re-Evaluation

Abstract

Decrease in oestrogen production starts well before menopause and initiates a continuous loss of bone. After menopause, in the absence of therapy 1 %–4 % of bone mass may be lost annually. In general, the indications for HRT were:

• Relief of postmenopausal symptoms and signs attributable to oestrogen deficiency

• Reduction of risk of diseases associated with oestrogen deficiency (osteoporosis and cardio/cerebrovascular disorders)

• HRT was thought to delay cognitive decline, but this has not been substantiated

• Long-term use (5–10 years) of oestrogen results in reduction of fractures of the hip, vertebrae, and arm by about 50 %. The greatest effect is seen in the vertebral column: within 2 years of HRT increases of up to 10% in bone density of the lumbar vertebrae, and up to 4% in the femoral neck have been reported. The effect of HRT is more pronounced in skeletal sites with mainly trabecular bone. When HRT is stopped, bone loss immediately resumes at the usual postmenopausal rate.