The therapeutic role of estrogens in postmenopausal women

From a historical perspective, we are currently in a transitional period in the cycle of the medical management of perimenopausal and the early postmenopausal woman. Until the mid-1980s and early 1990s, there was skepticism over the use of estrogens to alleviate the ill effects of the menopause. In the early 1990s, however, there was an almost unbridled enthusiasm for the use of estrogens not only for alleviating symptoms but also for the probable prevention of cardiovascular problems, which are common in older women. With the findings of the WHI and the similar results in studies of secondary prevention of coronary artery disease, there came a sudden reversal in the attitude toward the use of estrogens, which was not completely justified (see Table 2). Although the use of estrogens for the prevention of postmenopausal diseases has not been realized, its use for the treatment of estrogen-deficiency syndromes has been justified by many well-controlled studies. There may be women for whom estrogen treatment has major deleterious effects and others who do very well with this therapy. It remains to see if genomics and proteomics can identify both the women who would benefit and those who would be harmed by estrogen therapy. Furthermore, an understanding of the role of various progestins, often given with the estrogens to protect the uterus, requires more research. There is considerable room for more research in this important area because almost all women now live at least one third of their lifetime in the postmenopausal period. Many of the disorders affecting women in this age range are impacted by the presence or absence of ovarian hormones.