Women at midlife. Hormone replacement therapy.

As women approach the climacteric period, many changes are occurring in their bodies. Many of the physiologic changes are related to a decrease in estrogen production by ovaries. Hormone replacement therapy has been proposed to help relieve many of the manifestations associated with menopause. Before they begin hormone replacement therapy, women need to be informed about the advantages and disadvantages of this treatment. Decreasing the risk of cardiovascular disease and preventing further development of osteoporosis are primary reasons for administering hormone supplementation to postmenopausal women. The risk of breast cancer is not increased with low-dose estrogen, and by adding progesterone, the risk of endometrial cancer is virtually eliminated. Not every woman is a potential candidate for hormone replacement therapy. Contraindications exist, and some women experience discomforting side effects. Withdrawal bleeding with combination therapy is the main reason women do not comply with treatment protocols. Although supplementation may prove helpful for the postmenopausal woman, each individual needs to evaluate her own personal situation carefully. Accurate knowledge about normal changes due to decreased estrogen production, the pros and cons of therapy, and personal health status assists in the decision as to whether hormone replacement therapy is appropriate for a particular postmenopausal woman.