For decades, estrogen, either by itself or in combination with progestins has been the therapy of choice for the relief of menopausal symptoms. It is well known that hormone therapy may alleviate existing symptoms or even prevent the development of the most common menopausal symptoms.¹

Women at high risk for serious medical outcomes with the use of hormone therapy include the following:

• Breast cancer history
  
• Elevated risk for breast, ovarian, or both types of cancer on the basis of genetic factors, family history, or both
  
• Elevated risk for cardiovascular disease.

Women with these risk factors may be the most likely candidates for
non hormonal therapies to treat menopausal symptoms.

The 2005 NIH State-of-the-Science Conference on Management of Menopausal Symptoms concluded that estrogen therapy at doses equivalent to 0.625 mg of conjugated equine estrogen increases the risk for serious disease events, specifically stroke, deep venous thrombosis, pulmonary embolism, or both; and, when combined with progestin medroxyprogesterone acetate, coronary events and breast cancer.

In studies in which women were treated for 5 to 7 years, increased risks for coronary and thromboembolic events emerged in the first year of use. Risks for stroke began to increase after 2 years of use. Risks for breast cancer started to increase after 3 to 4 years of use. Although it is believed that long-term adverse effects associated with low-dose estrogen are lower, the precise risks and benefits remain unknown.²

Adverse effects of estrogen therapy include vaginal bleeding, breast tenderness and a slight increase in the risk of an estrogen-dependent neoplasm. An increased risk of developing endometrial carcinoma and hyperplasia has been conclusively related to unopposed, exogenous estrogen intake. Factors that determine the degree of increased risk include duration, dosage and method of estrogen delivery.³