Variations on HRT.
Older Menopausal Women
Older women in the past have been shamefully neglected due to the belief that the osteoporotic skeleton did not respond to drugs which otherwise would increase bone density in younger women. In reality the skeletal response to estrogen is greatest in women who had the lowest bone density and who are most years past the menopause. (38) It appears that this denial is occurring again following justifiable anxiety about the cardiovascular effects found in older women in the WHI study. These women require the lower starting dose of oestrogens or bisphosphanates may be used as a first option. If older women are treated with oestrogens it is advisable to start on low dose unopposed therapy for the first 3 months using oestradiol patches or gels or oral oestradiol 0.5mg daily. At 3 months after assessing the symptomatic response a decision should be taken whether to continue to use low dose unopposed oestrogens or to add a monthly low dose, low duration, progestogen component.