[Menopause and hormone replacement therapy (HRT) in women with diabetes].

This review is based on publications from 1996-1998 concerned research into hormone replacement therapy (HRT) estimated effect on metabolic factors in diabetic women. Coronary heart disease (CHD) and myocardial infarction are the main reasons of death in postmenopausal women. Evidence from many observational studies suggests that estrogen replacement therapy diminishes the mortality of healthy women due to CHD. Diabetes mellitus is an independent risk factor of CHD. The results of research show that estrogen replacement therapy decreases the death risk of myocardial infarction in diabetic women, too. Transdermal estrogens have beneficial effect on carbohydrate metabolism, attenuate glycemic control and decrease insulin resistance. We can observe favourable changes in fat distribution resulting in decreasing abdominal obesity. Diabetic women do not appear to experience as great changes in lipid profile response with HRT as do non-diabetic women. Women with diabetes had proportionally lower hormone-related decrease in total cholesterol and LDL cholesterol levels and increased HDL cholesterol level. The extent to which the beneficial effect of estrogen on lipoproteins is reversed depends on the type and dose of progestin added. Now, using HRT as secondary prevention of CHD in diabetic women, after consideration of an individual risk factor is recommended. We recommend preparations of 17 beta-estradiol administered transdermally and selected gestagens like dydrogesterone, norethisterone, medroxyprogesterone in small dosage.