J C Stevenson

..In conclusion, HRT should currently be used only for women with climacteric symptoms or an increased risk of osteoporosis, and it is important that there is an individualised approach to treatment based on each woman's risk profile...

..Based on current evidence transdermal HRT may also cause more irregular and breakthrough bleeding with sequential and continuous therapies than oral counterparts...

..Whilst the greatest CHD benefit may be seen by starting HRT in the early postmenopause, this does not exclude benefit in older women given appropriate low dose therapy...

..05) decreased, more so in the placebo group. There were no changes in matrix metalloproteinase (MMP)-2, or in LDL particle size. This transdermal HRT had beneficial effects on vascular function and CHD risk markers...

..Thus, no new safety issues have been identified, and the regulatory authorities may have misinterpreted the data from these recent studies. When given for the correct indications, HRT is of major benefit to many women...

..The introduction of estradiol plus drospirenone may offer the opportunity to re-evaluate the contribution of the progestogen component of hormone replacement therapy...

..This concept needs to be tested as a priority before hormone replacement therapies are rejected as being of no cardiovascular benefit...

..Skeletal benefits have been confirmed in terms of fracture reduction, as has a small risk of breast cancer development. Further studies of other HRT regimens are urgently required to clarify the cardiovascular effects...

..Women initiating HRT within 10 years of menopause onset may achieve cardiovascular benefit, particularly in terms of primary CHD prevention, whilst avoiding risks of stroke and venous thrombo-embolism...

..The preliminary WHI results do not reflect accurately true benefits and risks, and HRT should remain a potential preventive treatment for CHD...

..The primary aim of this double-blind, multi-centre, randomised study was to assess the efficacy of oral ultra-low dose continuous combined hormone replacement therapy with 17β-oestradiol and dydrogesterone...

..The raw data must be made available for independent assessment to obtain valid conclusions which may again change clinical practice...

..New treatments are emerging, but again caution must be taken until any long-term adverse effects have been identified...

..In this journey through a woman's life current best evidence relating to cardiovascular and musculo-skeletal risk will be reviewed in line with well documented management strategies...

..This study was undertaken to establish whether oral oestradiol plus dydrogesterone postmenopausal hormone therapy can modify these changes...

..Danazol treatment is not associated with loss of bone. Prolonged or repeated courses of treatment with goserelin alone could lead to a clinically significant adverse effect on the skeleton...

..The lower dose of estradiol-17 beta is a particularly suitable treatment for osteoporosis management in older women since it should minimize side-effects and improve the acceptability of HRT...

..The lower dose of oestrogen and the avoidance of cyclical bleeding make this a particularly suitable regimen for the prevention and treatment of osteoporosis in older women...

..There was no evidence that dydrogesterone compromised the 17beta-estradiol-induced improvements in lipid profile...

..Further studies are needed to determine whether the insulin-leptin axis plays a coordinating role in this syndrome and whether plasma leptin concentrations could provide an additional measure of cardiovascular risk...

..63 (95% confidence intervals 0.31-1.31)]. CONCLUSION: Low-dose HRT may give cardiovascular benefit. These findings require confirmation in a full clinical trial with evaluation of cardiovascular outcomes as the primary objective...

..Transdermal HRT may be preferred in women with coagulation disturbances. But, for the majority of women, personal preference should determine their choice of HRT route...

..Orally administered oestradiol had beneficial effects on total, LDL and HDL cholesterol which were unaffected by the addition of dydrogesterone...

..Associations with adiposity and liver enzyme activity suggest the involvement of hepatic fat deposition...

..This paper reviews the benefits and disadvantages of some of the main HRT delivery systems currently available...

..Danazol increased low density lipoprotein and decreased HDL concentrations to give a lipid profile associated with increased risk of CHD...

..To evaluate prediction of coronary heart disease (CHD) by quantitative measures of the metabolic syndrome and inflammation in a cohort of high socio-economic status males...

..Measurements in erythrocyte membranes support a role for membrane arachidonic acid content in the modulation of insulin sensitivity, specifically at low/normal insulin sensitivities...

..05) between the two phases of sequential treatment. CONCLUSIONS: Both oestrogen-only and oestrogen-progestogen HRT may reduce ACE activity in blood. Oestrogen and progestogen may exhibit additive effects on blood ACE activity...

..Such strategies need to be tested in large clinical trials. The metabolic effects of HRTs are key to providing cardiovascular benefit...

..HRT is a benefit, not a risk, for those women requiring it...

..We discuss these observations in terms of their potential clinical relevance and use as a means of screening novel oestrogen-like compounds...

..To evaluate the effect on bone mineral density of vaginal rings delivering estradiol acetate at two systemic doses versus a locally active vaginal ring in healthy postmenopausal women...

..In contrast, urogenital symptoms may be addressed efficiently and safely with long-term local estrogen therapy...

..Treatment of choice should be based on up to-date information and targeted to individual women's needs. Non-hormonal strategies may be useful for women with estrogen-dependent disease such as breast cancer...

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