Lege Artis Medicinae

[THE COMPLEX EFFECT OF TREATMENT TARGETING THE OESTROGEN RECEPTORS IN POSTMENOPAUSAL WOMEN]

TAKÁCS István, LAKATOS Péter

MAY 21, 2006

Lege Artis Medicinae - 2006;16(05)

[Hormone depletion after menopause results in the dramatic increase of the incidence of a number of diseases. It should seem reasonable to substitute female hormones to prevent or treat these disorders. However, hormone replacement therapy has not fulfilled the expectations in its current form. While the first large, prospective, randomized, controlled primary prevention trial showed a beneficial effect of hormone replacement on bone fracture and colorectal cancer, the incidence of cardiovascular diseases and breast cancer increased. The overall effect of treatment was assessed by the so called global index. Based on the global index, the overall health risk exceeded benefits from 5 years use of combined oestrogen plus progestin among healthy postmenopausal women. In another study, oestrogen alone did not affect the incidence of coronary heart disease or colorectal cancer, neither was the increase in breast cancer rate significant. Similarly to combination therapy, the beneficial effect on bone fracture rate and the adverse effect on the incidence of cerebrovascular events have remained. Overall, oestrogen monotherapy had no effect on the global index. There is not enough data available yet to draw a conclusion on the overall effect of fitooestrogens that also target oestrogen receptors and tibolon, a steroid hormone with tissue-specific effects. Raloxifene, a selective oestrogen receptor modulator considerably decreases the rate of vertebral fractures. In a study it also decreased the number of peripheral fractures in a subgroup of patients with severe vertebral fractures. It reduced the rate of cardiovascular and cerebrovascular events in patients at increased cardiovascular risk. The incidence of breast cancer dropped both in the original 4-year study period and in its 4-year extension. Based on the beneficial change of the global index, it is only raloxifen that can currently be recommended for the complex treatment of postmenopausal women.]

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