Health in the menopause: advances in management

摘要

Reliable estimates show that 10% of the global female population is currently either going through menopause or have already gone through it, and at least another 2% will reach this stage of life in the next decade The average woman who reaches menopause has a life expectancy of nearly 30 years, and many of the causes of morbidity in older women appear to be influenced by the subsequent decline in oestrogen levels Cardiovascular disease is the leading cause of death among women in industrialised countries and accounts for more than 40% of all deaths among women on a global scale The probability that a menopausajwoman will develop coronary heart disease (CHD) is 46% and 20% for stroke Postmenopausal hormone therapy (HT) is one of the most frequently prescribed drug regimens for women after the age of 50 Traditionally, the primary indication for HRT is to treat symptoms of menopause. Over the past decades, however, publicity about the possible ability of HT to prevent CHD, apart from also preventing bone loss, has contributed to increased HT use Most recently, however, the HT paradigm on the balance of costs and benefits has been impacted by puzzling information from several major randomized clinical trials. On a growing list, these studies have not shown any cardiovascular benefits from HT intervention Epidemiological studies are essential for generating new hypotheses, and in many situations, they will provide the best information Considering primary prevention of CHD, the strengths of the largest study conducted to date, the WHI study, are obvious but several shortcomings exist Moreover, the clinical interpretation is influenced by the fact that we are on a steep learning curve in pharmacoepidemi-ology and pharmacogenetics This points to the clinical relevance of also applying new findings from clinical studies on bio-markers and in vitro and animal research models The research priority has been to identify the mechanisms and markers of risk and this represents one of the greatest potential scientific advances today It can lead to the identification of women who will benefit from HT by preventing CHD, and also improve testing of hormones that do not trigger any pro-thrombotic activity