Variations on HRT.
Bleed free preparations
The desire to have estrogen therapy without a withdrawal bleeding opens up a large variety of therapeutic possibilities. The use of continuous estrogen and progestogen is effective, commonly used but is currently suspect because of the data from the WHI study. However it continues to be with justification the most frequently used preparation for this purpose. Recently there have been reports of low dose or ultra low dose continuous estrogens producing relief of symptoms and bone protection without bleeding. (27) Tibolone is a complex gestogen with estrogenic and androgenic properties, which by depressing SHBG (39) levels increases free testosterone thus having a beneficial effect on energy libido and depression. (40) The use of SERMS with their certain protective effect on breast cancer is being evaluated although this drug does produce vasomotor symptoms as well as the desirable endometrial atrophy and amenorrhoea.