Trattamento ormonale sostitutivo in menopausa: Benefici terapeutici e rischi preventivi

Hormonal replacement therapy is prescribed both to relieve menopausal symptoms and for preventive purposes. The preventive benefit, however, is dubious because the increased risk of breast cancer may be more important than the decreased risk of myocardial infarction and osteoporotic fractures. The transdermal administration may be associated with higher breast cancer risk and lower cardiovascular benefit than the oral administration; only the latter, in fact, is able to stimulate the liver synthesis of sex hormone binding globulin (SHBG, which reduces the availability of testosterone and estradiol to target organs) and of HDL cholesterol, and to inhibit the liver synthesis of IGF-I (which cooperates with sex steroids to enhance the breast cancer cell proliferation).