Estrogen and estrogen-progestogen replacement: therapy and cardiovascular diseases

The use of postmenopausal estrogens primarily to prevent heart disease should be reserved for women at high risk by virtue of an unfavorable low-density lipoprotein: high-density lipoprotein (LDL:HDL) ratio or the presence of manifest disease. Unopposed oral estrogen should improve lipoproteins within a few weeks, and this change, if sustained, should reduce the risk of cardiovascular disease. There is no reason to give progestins to a woman without a uterus. The management of a woman with an intact uterus is less well defined, given the unknowns about progestin's long-term effects on lipids or the heart.