Estrogen Management

Estrogen management has both risks and benefits; the balance is probably positive for most post-menopausal women, but individualized counseling should be done.

The benefits include the following:

• Reduction of heart disease, apparently mediated by beneficial changes in lipid profiles;

• Reduction of osteoporosis with decreased hip and vertebral fractures;

• Reduction in stress incontinence (see figure)

• According to recent studies, a diminished mortality risk for older women and possible reduction in memory loss with age.

The risks include:

• Increased risk of endometrial cancer, especially with unopposed estrogen use;

• Risk of recurrence or faster growth in women with pre-existing breast cancer;

• A possible increased risk of breast cancer in women with no prior history.

• Side effects frequently include breast tenderness and bleeding.

In women with a uterus, concurrent treatment with a progestational agent should be given. The usual medications used are conjugated estrogen 0.625 mg qd with progesterone 2.5 mg qd. This regimen prevents the need for cycling on and off both drugs and reduces the buildup of endometrial tissue so that bleeding is less likely to occur.