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The First World Congress On:
Controversies in Obstetrics, Gynecology & Infertility |
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Hormonal Replacement Therapy: to Bleed or Not to Bleed
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Estrogen is important for the healthy functioning of many organs, and increasing evidence supports the use of long-term estrogen replacement in postmenopausal women to provide protection against heart disease, osteoporosis, Alzheimer’s disease, and colorectal cancer. However, the acceptance of chronic HRT continues to be a major problem for menopausal women, with less than 20% of estrogen-deficient women using estrogen replacement. Continuing use of hormonal replacement is determined to a large extent by effectiveness and acceptability of a particular regimen (i.e. control of symptoms with minimal side effects), as well as positive effects on the determinants of future illness, such as bone density, blood pressure and cholesterol levels, and cognitive function. Important reasons for lack of acceptance include fear of cancer, particularly of the breast, occurrence of vaginal bleeding, and premenstrual syndrome (PMS)-like symptoms that are associated with conventional hormonal replacement. These areas of concern will be addressed, particularly with regard to vaginally bleeding, and new regimens of HRT, which may improve acceptance, described. In addition, the anti-estrogenic effects of environmental toxicants, such as the aryl hydrocarbons present in cigarette smoke and air pollution, on bone density and cardiovascular status will be outlined. The potential use of a recently discovered natural aryl hydrocarbon receptor antagonist as an adjunct to HRT may result in improvement in menopausal health. These developments in HRT may lead to better acceptance of long-term therapy by menopausal women. |
