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In a recent paper, using a case history of a patient with classical menopausal symptoms, Martin and Manson have reviewed in short the recent data and controversies over hormone replacement therapy (HRT) and discussed hormonal regimens (oral, transdermal) and dosage, duration of therapy and alternative treatment options [1]. The main motif of the article is safety, namely, how to balance the potential benefits of HRT against the potential risks in early and late menopause, and ways to identify patients in whom this balance would be the most, or least, favorable. For example, the authors suggest to incorporate the Framingham Score (a tool for assessment of the 10-year risk for coronary heart disease) in decision-making and consider a cut-off point of higher than 20% risk in the first 5 years of menopause, or higher than 10% risk during years 6-10 after menopause, as a negative argument for prescribing HRT.


  • Amos Pines
    Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel


  1. Martin KA, Manson JE. Approach to a patient with menopausal symptoms. J Clin Endocrinol Metab 2008;93:4567-75. Published December, 2008.
  2. Utian WH, Archer DF, Bachmann GA, et al. Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society. Menopause 2008;15:584-602. Published July-August, 2008.
  3. Practice Committee of the American Society of Reproductive Medicine. Estrogen and progestogen therapy in postmenopausal women. Fertil Steril 2008;90(Suppl 3):88-102. Published November, 2008.
  4. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG Committee Opinion No. 420, November 2008: hormone therapy and heart disease. Obstet Gynecol 2008;112:1189-92. Published November, 2008.
  5. Gompel A, Rozenberg S, Barlow DH, et al. The EMAS 2008 update on clinical recommendations on postmenopausal hormone replacement therapy. Maturitas 2008;61:227-32. Published November 20, 2008.
  6. Pines A, Sturdee DW, Birkhaeuser MH, et al. on behalf of Board of the International Menopause Society. IMS Updated Recommendations on postmenopausal hormone therapy. Climacteric 2007;10:181-94. Published June, 2007.
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