Progestogen use in the menopause : main topic

Recent publications of prospective randomised controlled trials have called into question the role of progestogen use in menopausal women. Progestogens are necessary to protect the endometrium from the hyperplastic effect of oestrogen. Progestogens differ markedly in their effects on different organ systems. In the cardiovascular system, the less androgenic progestogens have potential advantages as regards their effect on lipid profile, direct vascular effect, insulin resistance and haemostasis. By virtue of their effect on breast tissue enzymes, progestogens may increase the concentration of oestradiol in breast tissue. Progestins differ in this effect. Less androgenic progestogens have a favourable effect on the apoptosis proliferation ratio in breast tissue. Individualisation of menopausal hormone therapy is important, especially in the high-risk patient.