Should women with diabetes mellitus receive hormone replacement therapy?

The benefits of hormone replacement therapy (HRT) in non-diabetic postmenopausal women are now well established. HRT improves climacteric symptoms and has beneficial effects on the cardiovascular system and the skeleton. In addition, recent studies suggest a reduced risk of Alzheimer's disease and colorectal cancer. Despite these beneficial effects, concerns continue regarding the increased risk of malignancy, thromboembolism and the possible deterioration in blood pressure. There are no long-term studies in women with diabetes who also receive HRT, so we cannot be certain of the benefits and risks in this population. We can postulate, however, and draw some conclusions from current data, which suggest that the risk/benefit ratio is similar to that for the non-diabetic population. Based on present information, postmenopausal diabetic women should be actively considered for HRT provided the physician is aware of the possible problems and the patient is sufficiently counselled to make an informed decision.