Treatment of the menopause: the swinging pendulum

Facts and views on the treatment of the menopause underwent dramatic swings during the last fifty years, from a non-issue fifty years ago to a must for the well-being of all postmenopausal women at the end of the 20 century. the enthusiasm for hormone replacement therapy (hRt) was smashed in 2002, after the publication of a large-scale prospective randomised study, the Whi trial, on health costs and benefits of hormonal therapy of postmenopausal women (Writing Group for the Women’s health initiative investigators, 2002). this study concluded that on balance the side effects of hormonal treatment of the menopause outweigh the potential benefits. the undue and mostly uncritical attention to this publication in the media alienated a great deal of doctors and patients from a treatment that hitherto was deemed to be a boon for the postmenopausal woman. Several editorials in leading medical journals cautioned against the use of hormone replacement therapy and they expressed stern criticism of the naïve belief of gynaecologists in the prophylactic benefits of hRt (herrington and howard, 2003; Sackett, 2002; Lagro-Janssen, 2003). it was only after years of debate between advocates and opponents of hRt and detailed additional analysis of the Whi trial that hRt could be put into its proper perspective. not only is hRt the most effective treatment of cumbersome menopausal symptoms that can be administered safely to all healthy women for a limited period of time, but the prophylactic properties of hRt with regard to cardiovascular disease and osteoporosis can and should be taken advantage of in appropriate cases. We aim to briefly outline the history of hRt and to propose what currently can be considered as reasonable guidelines for the treatment of postmenopausal women.