Estrogen replacement therapy: an overview

Article Abstract:

During menopause, around the age of 50 years, the ovaries stop releasing the female hormone estrogen. Although estrogen can be converted from another chemical produced in fat tissue, this source of estrogen would only be protective in obese women with abundant fat cells. Most postmenopausal women experience adverse effects of reduced estrogen. Estrogen replacement therapy is a method of replacing the estrogen no longer made in the body and it prevents the undesirable effects experienced during menopause. These changes occur in the genital and urinary organs, the central nervous system, heart, skin and bones. In the vagina, reduced estrogen can cause itching, bleeding and pain during intercourse. The structures holding the uterus and bladder in place can become weakened, unable to maintain normal tone. Urinary symptoms include pain during urination, incontinence and urgency. Hot flashes, which often occur during sleep, may be the symptom causing women to seek medical care. Menopausal symptoms may last up to two years. Depression and anxiety are often reported. Skin becomes less elastic due to a reduction in the collagen layer of the skin. During menopause bone thinning caused by osteoporosis results in reduced bone density. Although this may remain unnoticeable for ten years, fractures can result from the reduced bone mass. During menopause there is an increased risk of coronary heart disease caused by atherosclerosis of the arteries supplying the heart muscle. Estrogen can protect the heart by increasing high density lipoproteins and lowering low density lipoprotein cholesterol, thereby reducing atherosclerosis and preventing heart attacks. Postmenopausal women benefit greatly from estrogen replacement therapy, particularly if they have had their ovaries removed. The universal recommendation of estrogen replacement therapy is hindered by the association between estrogen and cancer. Estrogen given alone can increase the risk of endometrial cancer, cancer of the cells lining the uterus. The addition of progesterone reduces the risk of cancer so that it is equal to that of untreated postmenopausal women. Since replacing estrogen can protect women from the undesirable effects of estrogen loss, estrogen replacement therapy should be offered to all postmenopausal women. It should not be used in women with clotting disorders, liver disease, or breast or endometrial cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects

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Effects on bone of surgical menopause and estrogen therapy with or without progesterone replacement in cynomolgus monkeys

Article Abstract:

The effect of estrogen replacement therapy on bone loss associated with menopause was assessed in cynomolgus macaques, a type of monkey. Menopause, the cessation of the menstrual cycle, was surgically induced in these animals by removal of their ovaries. The animals were divided into three groups: females that underwent oophorectomy (removal of the ovaries) but were otherwise untreated; females that underwent oophorectomy and were treated with estrogen and progesterone; and females that underwent oophorectomy and were treated with estrogen. The bone mineral density, which is a measure of bone mass, was lower among untreated monkeys as compared with animals treated with either estrogen alone or estrogen and progesterone. The bone mass index, a measure of bone mass, was greatest in monkeys treated with progesterone and estrogen, intermediate in monkeys treated with estrogen alone, and lowest in untreated monkeys. These findings suggest that estrogen treatment with or without progesterone protects against bone loss resulting from menopause, which was surgically induced by removal of the ovaries. The cynomolgus macaque serves as a useful animal model for studying the effectiveness of estrogen replacement therapy in preventing bone loss after menopause. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Prevention, Complications and side effects, Osteoporosis

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Estrogen replacement therapy: what the future holds

Article Abstract:

During menopause the ovaries stop producing estrogen. Women are now living 30 years beyond the average age of the onset of menopause, spending one third of their lives without the protection of estrogen. Most women develop symptoms associated with the mental, physical and emotional changes of menopause. Estrogen replacement therapy can reduce symptoms of menopause, prevent osteoporosis and reduce the incidence of coronary heart disease. Adverse effects include a higher risk for endometrial and breast cancers. However, the benefits outweigh the potential risks. The risk of endometrial cancer has been reduced with the addition of progesterone to the estrogen hormone therapy regime. The role of estrogen in producing breast cancer is not yet clear. Improved combination therapy with better dosage regimes may also improve patient drug therapy compliance. It is the general consensus that all postmenopausal women should receive estrogen replacement therapy. Women with absolute contraindications should not be considered candidates for estrogen replacement therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

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