Postmenopausal hormone therapy: the way ahead

This article follows the milestones in the history of postmenopausal hormone treatment, with a look into the future. In the first era, hormones were regarded as an anti-aging panacea, the fountain of eternal youth. It was recommended then that every postmenopausal woman should consider the use of hormone replacement therapy. In the second era, people realized that hormones are medications, and as such should be given for clear and scientifically proven indications. When the issue of harm as a result of hormone treatment led to professional and public debates, the concept was changed into a clinically oriented approach commonly phrased as "the expected benefits should be weighed individually against potential risks". In the third era, individualization had a further step, stressing the prognostic importance of the following parameters: women's age, age at start of hormone use, duration of therapy, dosage, route of administration, and the exact type and combination of estrogen and progestogen. The fourth era is already knocking on our door, as new molecules are sought, which will maximize the desired effects of therapy while minimizing or eliminating the risks. The fifth era is still a wishful thinking, searching for the ultimate treatment which will be based on individual gene mapping and accurate assessment of the chance to achieve treatment goals vis-à-vis the risk of having a serious adverse event.