To improve the quality of healthcare for women, authors Winnifred Cutler, Ph.D. and Elizabeth Genovese-Stone, M.D. offer recommendations to the general practitioner and internist readership, based on scholarly review of significant studies through August 1998, citing 250 references. The seven years before menopause have recently been revealed to be an extremely complex era. Coupled to this variability in estrogen is an equally variable set of changes in progesterone secretion by the ovary as androgen secretion patterns also change.
Many women show increases in circulating androgens while many others show deficiencies.
Each of the known ovarian and adrenal steroid sex hormones plays numerous roles in maintaining the harmonious workings of the entire self. Studies of post-40 year old women on HRT have been reviewed to assess the benefits and risks of various regimens. Given diverse regimens of both natural and synthetic hormones, physicians should consider results of each study as specific to the type and pattern of hormone use and only generalize with caution. The harmonic nature of the fertile reproductive system forms the background against which HRT can be understood to best serve women. Not all hormonal replacement therapies and wellness regimens serve women well.