Estrogen Deficiency States
Hormone therapy (HT) can be used to manage problems associated with the decline in ovarian estrogen production after menopause. Low levels of estrogen may affect many organs, including the brain, skeleton, and skin as well as the cardiovascular and genitourinary systems. The frequency and severity of menopausal symptoms, the reaction of target tissues and organs to estrogen deficiency, and the response to HT vary significantly among women. It is clear that estrogen replacement is an effective means of preventing bone loss and fractures in postmenopausal women.
The goals of menopausal HT are:
- to reduce symptoms resulting from estrogen depletion, including hot flushes, sleeplessness, lethargy, and depressed mood
- treat urogenital atrophy and vaginal dryness
- minimize the risk of side effects and complications relating to HT
A standard treatment applied to all menopausal women will not necessarily meet the needs of many individual women. Health care providers must always consider a balance between the benefits and risks of treatment for the individual patient before recommending HT.
The following article is from the Practice Committee of the American Society for Reproductive Medicine and focuses first on the effects associated with such treatment. It reviews the evidence concerning the effects of HT on the risk of osteoporosis and related fractures on the risks of coronary artery disease, dementia, and colorectal cancer. The long-term effects of HT on the risks of stroke, venous thromboembolism are discussed.
The second article is a review of estrogen from a European group, the EMAS.
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