MENOPAUSE AND HORMONAL REPLACEMENT THERAPY – HISTORICALREVIEW
Abstract
BACKGROUND In the 17th, 18th and 19th century the scientists were intensively occupied with »climactericdisease« in men and it was not until 20th century when attention was paid to climacteric offemale too. In the second half of the 20th century hormone replacement therapy (HRT)became popular for alleviation of climacteric symptoms and prevention of osteoporosis.Together with beneficial effects of HRT unwanted side effects were registered.Several large scale hormone trials (Nurses Health Study, Heart and Estrogen-progestinReplacement Study – HERS, Estrogen Replacement and Atherosclerosis – ERA, Postmenopausal Estrogen/progestin Interventional Trial – PEPI, Women’s Health Initiative – WHI,The Million Women Study, Raloxifene Use in the Heart – RUTH) revealed an increased riskfor the development of invasive breast cancer and cardiovascular events and decreasedrisk of colorectal cancer and osteoporosis. Overall criticism of the mentioned trials concerns the age of women included in the studies (more than 60 years on average). Recentmeta-analysis of randomized trial shows 40 % reduction in total mortality in women whostarted HRT younger than 60 years at baseline. This analysis provides a promising evidence of HRT emphasizing early start i.e., in the first years after menopause. CONCLUSIONS Last decade in the field of menopausal medicine is characterized by discussions aboutbenefits and risks of HRT. The experts reached consensual position statement that benefitsovercome risks of HRT when introduced in early postmenopauseDownloads
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