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Treatment Regimens for the Menopause Current Topics in Menopause 327
to sixty years, it has also been recommended as a prophylactic to reduce the risk
of osteoporosis, cardiovascular damage and Alzheimer's disease. But in spite of
what has been regarded as major benefits for estrogen, adverse opinions have
gained credence in the community because of contrary results from research
studies into the effect of sex hormones on post-menopausal women.
So What are the Issues which Have Provoked this Controversy?
Most of the contrary points of view relate to an increased risk of breast cancer,
cardiovascular events and Alzheimer’s dementia reported in the Women's Health
Initiative Study, published in 2002, when equine estrogen and medroxyprogesterone
acetate was used in an oral hormone therapy regimen to treat postmenopausal women.
The fact that different forms of hormone therapy, delivered by different routes to
younger women passing through the menopause, may be beneficial, appears to
have been ignored by those epidemiologists and health professionals who
currently oppose the use of HRT. In this chapter information about therapy
regimens, routes of delivery, dosages and their effect on younger women will be
reviewed particularly in relation to breast cancer, cardiovascular disease and
dementia. As well as hormone therapy, other treatment regimens for osteoporosis
and alternative therapies for vaso-motor symptoms will also be reviewed.
HISTORICAL OVERVIEW
The symptoms currently acknowledged as being typical for women experiencing
the menopause have, for thousands of years, been accepted as peculiar to older
members of the female community, but it was not until the early 19 th century that
this cluster of symptoms was clearly identified as coinciding with the age at which
women ceased to menstruate. Episodes of heat (flushes), emotional mood swings,
depression, sexual dysfunction and even osteoporotic fractures have been
described in early Egyptian, Greek, Persian, Roman, Arabic, Chinese and Indian
texts but it is difficult to determine whether the symptoms were consistently
recorded as a sequel to, or associated with, the menopause.
It was thought by both the Hippocratic and Aristotle schools of health and hygiene
that as women aged they no longer produced an excess of the nourishment necessary