Therapeutic considerations in the management of the climacteric. A critical analysis of prevalent treatments.

The natural aging process affects a woman greatly during the climacteric; hormonal patterns, metabolic parameters, reproductive target organs and bone are involved. In every instance one can compare these changes with the effects of hormone-replacement therapy (HRT) on these same parameters. Therapy should reverse the negative trends imposed by the aging process and preserve the status quo. The approach must be holistic, and consideration must be given to the effects of HRT on all the parameters and not just to the uterus as the sole end point. Ideally the smallest amount of hormone should be used that will effectively treat symptoms and favorably affect metabolic parameters, the reproductive target organs and bone. Since recent clinical evidence has emphasized the protective nature of estrogen-plus-progestagen therapy in the prevention of endometrial and breast cancer and of osteoporosis, combination therapy is an essential feature of treatment. The shortfalls in our knowledge of the ideal therapy are undeniable. However, it is crucial to provide hormonal support with the available therapy to the woman suffering from estrogen-deficiency symptoms, particularly in view of the high mortality rates associated with postmenopausal osteoporosis, a preventable disease.