Postmenopausal Estrogens—Opposed, Unopposed, or None of the Above

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Abstract
Postmenopausal estrogens can reduce menopausal symptoms, risk of osteoporotic fractures, and probably coronary heart disease. Adverse effects include venous thrombosis and cancers of the endometrium and breast. The increased risk of breast cancer is primarily among current or very recent estrogen users and is directly related to duration of use.1 Addition of progestin to estrogen largely mitigates the increased risk of endometrial cancer,2 and combination therapy (opposed estrogen) has become the standard hormonal regimen for women with a uterus. The impact of combined estrogen and progestin on risk of breast cancer has been controversial. Although protective effects analogous to those for endometrial cancer have been hypothesized for breast cancer, cyclical use of progestin to simulate normal menstrual cycles increases mitotic activity in the breast.3
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