Estrogen therapy

In postmenopausal women, estrogen therapy reduces bone resorption and BMD loss, and reduces the incidence of fractures. However, its use is limited by the risk of adverse effects with long-term use (eg some cancers). Evidence suggests that the risk of harm is lower when estrogen therapy is started in younger women than in older women, with a low absolute risk of harm if estrogen is used within 10 years of menopause. Lower risk is also observed in women who take estrogen alone (ie women who have had a hysterectomy) rather than combined therapy.

Discuss the harms and benefits of therapy with the patient. Estrogen therapy is typically used in postmenopausal women who are younger than 60 years, particularly those who have another indication for estrogen therapy (usually menopausal hormone therapy).

Oral estradiol or estradiol valerate (2 mg per day), or the equivalent dose of transdermal estradiol (delivering 50 micrograms per 24 hours) are thought to be adequate for bone protection (see ../../Sexual_and_Reproductive_Health/srg/c_srg2-c24-s7.html#srg2-c24-s7__tsrg2-c24-tbl3 for estrogen preparations). However, lower estrogen doses may also reduce bone loss. Women with an intact uterus treated with estrogen therapy must also take adjuvant progestogen therapy, to prevent endometrial hyperplasia (see Cyclical combined systemic MHT and Continuous combined systemic MHT).

In a woman with premature ovarian insufficiency or early menopause, estrogen therapy is required (in the absence of contraindications) until the typical age of menopause, regardless of BMD status.