[Differential use of sex hormones during the perimenopause]

Various regimens are available for hormone replacement in perimenopausal patients. Their pharmacodynamic effects differ e.g. in respect to the relief of subjective climacteric symptoms, the risk of endometrial cancer, the prevention of osteoporosis and the alterations of lipid metabolism. In view of the conflicting epidemiologic data general long-term prophylaxis in all climacteric women cannot be recommended at present. The institution of therapy requires valid indications and careful assessment of relative risks. Today, the cyclic administration of oral estrogen-progestin combinations may be regarded as the method of choice. However, treatment can and should be individualized. The practical aspects of a differential management are discussed. With prudent use, the benefits of perimenopausal hormone replacement clearly outweigh their potential disadvantages.