Historical perspectives in postmenopausal hormone therapy: defining the right dose and duration

Recommended dosages of postmenopausal estrogen therapy (ET) and estrogen-progestin therapy (EPT), like those of oral contraceptives, have decreased markedly since oral estrogens were first introduced. Recently, the movement toward lower doses of ET/ EPT has accelerated because of the results of the Women's Health Initiative, which showed that lower-dose ET/EPT may provide similar efficacy and an improved safety profile compared with higher-dose preparations. For example, lower ET/EPT doses effectively relieve vasomotor and vulvovaginal symptoms associated with menopause, prevent bone loss, protect the endometrium, and are better tolerated than commonly prescribed doses. Current guidelines suggest the use of the lowest effective dose for the shortest duration consistent with treatment goals, benefits, and risks for the individual woman. However, the impact of treatment discontinuation should be considered when advising women to use hormone therapy for relieving menopausal symptoms for the shortest possible duration.