Perimenopausal hormone replacement therapy Review of the literature

Perimenopausal and postmenopausal hormone replacement therapy Part 1. An update of the literature on benefits and risks*1

“…In 1991, when JNM published its last review of the literature on menopausal hormone replacement therapy, it was reported that estrogen use had peaked in 1975, with 28 million prescriptions written in that year for non‐contraceptive estrogens. Subsequently, estrogen usage dropped, following numerous reports in the late 1970s of an association between estrogen therapy and endometrial cancer (5), with a decrease of about 50% in prescriptions written in 1980, compared with 1975 (9). In 1984, however, the National Institutes of Health held a Consensus Conference on Osteoporosis, which strongly recommended estrogen as a preventive measure against this disabling and even fatal condition.…”

“…Cross‐cultural studies have reported on cultures where menopausal symptoms are not seen (33,34). This includes even hot flashes or flushes, widely believed to be unequivocally related to the physiologic changes associated with hormonal shifts occurring at menopause and during the years preceding and following it (5). Studies on symptom prevalence tend to be cross‐sectional, rather than longitudinal, so that women's past reporting of symptoms cannot be evaluated.…”

“…Although the precise mechanism by which decreased levels of estrogen are related to this prevalent vasomotor symptom remains unclear, ERT is a highly effective treatment. Although studies have tended to be short term with small numbers of subjects, they have included well‐designed, prospective, double‐blind trials, with random assignment to treatment and placebo groups (5). Several studies utilized crossover designs, which means that subjects were switched from treatment to control group (or vice versa) without their knowledge or the knowledge of their care providers (43,44).…”

“…Vaginal changes constitute the second menopausal symptom for which data support the use of estrogen as an appropriate and effective treatment. Estrogen has been demonstrated to increase vaginal lubrication, blood flow, and tissue elasticity and decrease thinning of the vaginal walls, vaginal wall friability, vaginal pH, irritation, susceptibility to infection, dyspareunia, and related loss of sexual desire (5). Studies have been carried out with systemic and local estrogen, and both have been found effective for this symptom.…”

“…In early 1991, the Journal of Nurse‐Midwifery ( JNM ) published an extensive review of the literature on perimenopausal hormone replacement therapy (5). In the years since that review was published, the literature on hormone replacement therapy has burgeoned.…”