Middle Age
HRT - the mainstay of treatment.
HRT offers benefits at any age which may be maintained long-term. HRT has been shown to
conserve bone mass and decrease fracture risk in osteoporotic women even in their late
60's.There is a possible 30% increased risk of breast cancer after 10 years treatment with
HRT but this needs to be put into perspective:
- Annual incidence of breast cancer for women 50-60 is 2.0/1000
- Annual incidence of breast cancer for women 50-60 who have been using HRT for 10 years
or more is 2.6/1000
This slight risk increase is generally outweighed by the benefits of preventing fractures,
protection against cardiovascular disease and perhaps a reduction in risk for alzheimers
disease.
Use for:
- Postmenopausal women: reduces hip and vertebral fractures and protects against heart
disease.
- Natural menopause before 45.
- Surgical menopause: in hysterectomised patients with ovarioan conservation, 20%
experience menopause within 2 years of operation.
Treat for at least 5-10 years.
To conserve bone requires
- 0.625mg/day of conjugated oestrogen orally
- 2mg/day oestradiol orally
- 2mg/day oestradiol by patches
Continuous combined oestrogen/progestogen should not be prescribed until at least 12
months after the last natural menstruaal period. 90% of women will be amenorrhoeic 1 year
after commencing continuous combined therapy.