Factors of impotance for women's health at midlife with special emphasis on effect by sex steroids

Menopause is not a disease, but may bring about a wide range of health complaints and increase some risks of illnesses. The aim of this study was to evaluate the general health status and influences of background factors on symptomatology among a cohort of Swedish women aged 50-64 years, with specific emphasis on the effects of hormone replacement therapy (HRT) by investigating a profile of HRT use, long-term effects of HRT by different tapes and routes of administration as well as clinical and metabolic changes by use of low dose HRT. A total of 6917 out of 10870 women (64%) answered a questionnaire and underwent physical and laboratory examinations. Hot flushes were the predominant complaint and peaked during the first year after menopause (57%). Socio-demographic characteristics, lifestyles and concomitant health problems appeared to influence the symptomatology. Psychological problems were abundant in 85% of women, but mood disturbances were not found to have significant relation to menopausal status. The most common somatic symptoms were headache, pain in back and/or leg and joint problems. The prevalence of symptoms differed by hormonal status. The proportion of current HRT users was 39%. In long-term HRT users the addition of a progestogen compromised beneficial effects of the estrogen on women’s emotional well-being and psychosexual activity. Transdermal therapy exhibited not only more apparent therapeutic effects but also more adverse side-effects in comparison with the oral route. A 12-month randomized controlled trial examined the changes of serum lipid profiles and carbohydrate metabolism in healthy post-menopausal women by low doses of estradiol (E2) in combination with norethisterone acetate (NETA). It was found that the low dose therapies, especially the formulation of E2 1mg + NETA 0.5mg, exerted favorable effects on the lipid profile as well as on carbohydrate metabolism