Postmenopausal oestrogens and arteries

Postmenopausal oestrogen use is associated with a significant reduction in cardiovascular morbidity and mortality. The fact that a large scale controlled trial has not been conducted is a valid criticism, but the epidemiological data are compelling and there is evidence of biologically plausible mechanisms which may mediate this effect. Postmenopausal HRT also abolishes climacteric symptoms and conserves bone. For the postmenopausal woman who has had a hysterectomy, unless there are compelling reasons to the contrary, we believe that unopposed oestrogen therapy should be offered routinely. Women who still have a uterus (and these form the majority of potential HRT users) require oestrogens with cyclical progestogens. Whether such opposed therapy results in any reduction in cardiovascular protection needs to be addressed urgently. Meanwhile, it could be argued that these women should also be offered HRT routinely. Indeed, a recent consensus conference (Lobo & Speroff 1994) concluded that because of the magnitude of cardiovascular disease as a cause of morbidity and mortality, the beneficial role of estrogen in the primary prevention of cardiovascular disease in most women outweighs its potential risk. At the present time, there are insufficient data to indicate whether there are any groups of women for whom the risks may be too great to prescribe some form of estrogen therapy. As life expectancy increases in developed countries, such reductions in the leading cause of mortality are likely to benefit not only the individual woman, but the society in which she lives.