Selections from current literature: hormone therapy in postmenopausal women

The articles reviewed for this issue of 'Selections' concern potential therapies to prevent osteoporosis and cardiovascular disease in postmenopausal women. Each therapy is controversial and provokes more questions than answers. The most benign intervention is the administration of calcium to postmenopausal women whose daily calcium intake is less than 400 mg. Although there have been reports that calcium administration failed to demonstrate benefit in this group, the treatment is unlikely to do harm. Etidronate can increase bone mineralization in women with osteoporosis, but will it be useful for prophylaxis? Oestrogens can prevent bone loss, but is the increased risk of breast cancer sufficient to preclude their use? Do oestrogens increase or decrease the risk of cardiovascular disease? A combination of oestrogen and progesterone may avoid the increased risk of uterine cancer but what are the effects of long term administration? Do the potential benefits of hormone therapy justify the costs and treatment of large numbers of women who without therapy would never have developed complications attributable to oestrogen lack? (Herman J: Fam Phys 1990; 18: 39-40) Given these uncertainties, is postmenopausal administration of hormones reasonable or prudent? The current literature does not provide adequate answers to these questions. Uncertainty, however, is not new for clinicians, who will weigh the evidence, evaluate the multiple variables in the individual patient that influence therapy, and with their patients decide whether the risks outweigh the benefits.