The climacteric is an interval characterized by a multitude of physiologic, psychologic, and sociologic alterations that result in an individual's adaptation to life beyond reproduction. The common denominator of the physiologic changes is the loss of functional ovarian follicles and their ability to produce estradiol. The relative estrogen deficiency results in a myriad of systemic changes, some of which in themselves may impair the quality of life or be life-threatening. Estrogen replacement therapy is effective in alleviating some of these changes, including osteoporosis, vasomotor symptoms, and genital atrophy. This treatment, however, confers additional risks, endometrial adenocarcinoma being the one of greatest concern. This risk can be reduced by carefully selecting patients to be treated, closely following them, minimizing the duration and amount of exposure, and adding a progestin to the regimen. It is hoped that the risk of endometrial cancer and other adverse reactions associated with estrogen use can be further reduced when more data regarding optimum dosage and choice of agents are available.
