Fine Thning of HRT
Goran Samsioe, M.D., Ph.D.*
Affiliation : *Department of Obstetrics & Gynecology, Lund University Hospital, S-22185 Lund, Sweden.
Despite the ostensible benefits of hormone replacement therapy in postmenopausal women the usc of such preparations is limited to a fairly low percentage of eligible candidates. The reasons for this are severalfold. Information about benefits is often scanty and side effects by HRT are often believed to be the same as by oral contraceptives. Mass media have often played an ugly role in this respect by exaggerating side effects. especially the risk of breast cancer and underestimating the benefits. Improved awareness of HRT is highly warranted among the lay public as well as among health professionals inclusive of politicians. Admittedly HRT may have side effects which in most cases can be overcome by a finer tuning of HRT. Unfortunately, there is no single test nor a battery of test which beforehand can tell us what preparation would be most suitable for a given individual. It is of vital importance that the patient is made aware of this fact prior to insertion of therapy and offered a revisit to the clinic in 3-4 months time. Pharmacokinetics and indeed also pharmacodynamics may vary from one individual to another and dosing of the oestrogen as well as the progestogen. which may be too low in one individual. are clearly too high in another. A metabolic steady state is more easily obtained with the oestrogen components as the liver is often capable of tuning the metabolism of human compounds. All commercial preparations contain artificial proges- togens and metabolism of these may be more cumbersome and variable. Progestogenic side effects are common and often the reason as to why women cease to use HRT. Type. dose and duration of progestogenic co-medication is of importance in this respect whereas mode of administration has less an impact. Oral preparations are available in fairly crude steps of amount. Using matrix patches or creams dose can be individualised to a much greater extent. This is particularly prudent for oestrogens, but matrix patches with a progestogen will soon enter the market.
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