An Overview of Estrogen Replacement Therapy in Postmenopausal Women

The purpose of this review is to describe trends in the postmenopausal use of estrogen either alone (estrogen replacement therapy or ERT) or in combination with progesterone (hormone replacement therapy or HRT), and to identify themes in ERT and HRT use that might be helpful in increasing the appropriate use of postmenopausal hormones. We reviewed the findings from 31 articles published since 1987 and identified from MedExpress and Medline searches of English language literature. We found that among surveys of postmenopausal women, 12%–32% of women reported the current use of ERT or HRT; fewer than one-fourth of current users took HRT. Compared to women with a natural menopause, women with a surgical menopause were two to three times more likely to use postmenopausal estrogen. Most users took low dose oral conjugated equine estrogen (.625 mg) cyclically for two years or less. Physicians reported a higher rate of prescribing ERT and HRT than women reported using. The features that distinguished users from nonusers included: white race; higher socioeconomic class; lower weight; better cardiac risk profiles; knowledge about the effects of postmenopausal estrogen; beliefs consistent with the medical model; and access to routine medical care. These findings indicate that the majority of postmenopausal women do not use ERT or HRT; among postmenopausal women who use hormone therapy, most do not appropriately combine estrogen with progesterone. To increase the appropriate use of estrogen replacement therapy, we suggest the following are needed: programs to educate women and physicians about the menopause; better information about the risks and benefits of ERT and HRT; and additional data about postmenopausal estrogen therapy use in understudied populations.