January 2, 2018

Summary

Menopause occurs at about age 51
Most chronic conditions, like heart disease, dementia, stroke, fractures, and breast cancer, increase with age; can it be attributed to menopause alone? not known  

Treatment with Combined Estrogen and Progestin 

1. has no benefit for the primary prevention of chronic conditions
2. has a moderate benefit in reducing the risk of fractures and a small benefit in reducing the risk of diabetes and colorectal cancer
3. is associated with moderate harms, including increased risk of invasive breast cancer and venous thromboembolism, and a small to moderate harm of increased risk of coronary heart disease, increased risk of stroke, dementia, gallbladder disease, and urinary incontinence.

Treatment with Estrogen

1. Estrogen Alone is restricted to women who have had a hysterectomy, because estrogen taken alone increases the risk of endometrial cancer in women with a uterus. 
2. use of estrogen alone has a moderate benefit in reducing the incidence of fractures in postmenopausal women
3. use of estrogen alone has a small benefit in reducing the risk of diabetes and breast cancer 
4. estrogen use does not have a beneficial effect on risk of coronary heart disease.
5. estrogen alone has no benefit for the primary prevention of chronic conditions 
6. estrogen alone is associated with increased risk of stroke, dementia, gallbladder disease, urinary incontinence, and venous thromboembolism.

Breast Cancer

The reason for difference in use of estrogen alone compared with combined estrogen and progestin on the risk of invasive breast cancer is unclear. Combined estrogen and progestin is associated with a small increase in the risk of breast cancer, while estrogen alone appears to slightly reduce this risk. Estrogen stimulates breast cell proliferation, but some studies have shown that estrogen can induce breast cell death if administered under conditions of estrogen deprivation, and that progestin can stimulate breast cell proliferation and formation of new blood vessels. 

Traditionally, estrogen has been viewed as having protective effects on the heart because heart disease in premenopausal women is lower than in men of the same age. Estrogen decreases levels of low-density cholesterol, increases levels of high-density cholesterol, and has a vasodilator effect. Clinical trials show no benefit, or even harm, of hormone therapy on the risk of heart disease in postmenopausal women. The underlying causes of this lack of benefit are uncertain.

Breast Cancer Prevention

The use of medications such as tamoxifen and raloxifene in women at increased risk of breast cancer who do not have contraindications and are at low risk of adverse medication effects is a strategy to reduce risk of breast cancer.

Prevention other

The USPSTF recommends daily use of low-dose aspirin to decrease the risk of colorectal cancer and cardiovascular disease in appropriate candidates.