May 2003 · Vol. 15, No. 5From the Women’s Health Initiative to clinical practice: A 5-point plan
A seasoned physician offers practical guidance on postmenopausal use of estrogen and progesterone.
ANTHONY
A.
LUCIANO,
MDDr. Luciano is professor of obstetrics and gynecology, University of Connecticut School of Medicine, and director, the Center for Fertility and Women’s Health, New Britain General Hospital,
New Britain, Conn.
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KEY POINTS
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Give estrogen and estrogen-progestin therapy only for the relief of significant vasomotor symptoms, and halt the therapy in all asymptomatic women.
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Prescribe natural estrogens and progesterone whenever possible and measure serum levels to assess response and compliance.
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Initiate therapy at a dose of 0.3 mg for conjugated equine estrogen, 0.5 mg for oral estradiol, and 0.035 mg for transdermal estradiol and progressively increase, if necessary, to no more than twice these amounts.
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Give progesterone cyclically rather than continuously to reduce risk of cardiovascular disease, breast cancer, other adverse events.
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Reassess regimens annually in each patient.
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After our usual Saturday morning match, my tennis partner asked if I still prescribed estrogen and progestin therapy (EPT) for menopausal women. He had, of course, seen recent reports of the Women’s Health Initiative (WHI) findings (TABLES 1 and 2).1
I replied that most of my symptomatic postmenopausal patients continued taking estrogen therapy (ET) or EPT. Still, I understood the concern that prompted the question.
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