Risks and Benefits of Hormone Replacement Therapy

Abstract

Menopause, the permanent cessation of menstruation, is due to ovarian failure, which may lead to oestrogen deficiency diseases, particularly osteoporosis, cardiovascular disease and cerebrovascular disease. Mortality and morbidity caused by these conditions can be modified by using hormone replacement therapy, but the benefits of this therapy must be weighed against the increased risk of breast cancer and the symptomatic side-effects the treatment may cause. The combination of transdermal oestrogen and natural progesterone offers the most favourable risk-to-benefit profile.

Hormonal management of migraine at menopause

“…40 On the other hand, the cyclic administration of progestins, which is mandatory in non-hysterectomized women, may induce migraine attacks. 41 In these cases, on the basis of their clinical experience Silberstein and Merriam 42 suggested the use of a progestin with low androgenic properties or a natural progesterone and the switch to combined estrogen–progestin continuous therapy, while Panay and Studd 43 proposed progesterone-releasing coils and vaginal progesterone to minimize systemic side-effects in progestogen-intolerant women. MacGregor 44 in a preliminary uncontrolled retrospective study suggested that transdermal oestradiol was associated with more improvement in migraine than oral conjugated estrogens.…”