Menopause: new indications and management strategies

Postmenopausal women may benefit from estrogen replacement. In addition to the well-established treatment indications of vasomotor symptoms, genitourinary atrophy, and osteoporosis, studies also suggest improvement in psychologic well-being and prevention of coronary heart disease. The potential cardioprotective effects of estrogen do not appear to be solely from alterations in lipid metabolism. Major risks of estrogen replacement including breast cancer continue to be a concern. Strategies of management including continuous estrogen and progestin regimens are reviewed. There exists an increasing body of evidence that successful treatment for estrogen-dependent tumors including endometrial carcinoma is not a contraindication to estrogen replacement therapy. The potential use of tamoxifen to relieve symptoms and prevent bone loss in women with breast cancer is suggested.