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Introduction

Estrogen production declines in women when ovarian function changes with aging or after surgical removal of the ovaries. This drop in estrogen levels can trigger a vasomotor response resulting in a sensation of flushing and sweating that interferes with function and sleep (hot flashes or flushes). Other symptoms, such as mood changes and urogenital atrophy, contribute to reduced quality of life for many women. Several other effects on health also occur because estrogen receptors are located in many areas of the body and estrogen has interactions with processes such as blood clotting. Studies conducted in recent years have identified additional health benefits of postmenopausal estrogen besides symptom management (osteoporosis) as well as potential harms (cardiovascular disease, breast cancer, and cholecystitis). Estrogen was approved as a hormone supplement in the 1940’s to treat estrogen withdrawal symptoms in menopausal women. A national survey conducted in 1995 indicated that 37% of women age 50 and older were using estrogen for multiple purposes []. More recent US national data indicate that hormone use in postmenopausal women has declined following publicity about the potential harms of postmenopausal estrogen use [].

Evidence Tables

Head to head trials with hot flash/flush or other symptom outcomes

Results

Prior to Update #3, electronic searches identified 1,426 citations: 94 from the Cochrane Library, 735 from MEDLINE, 479 from Embase, 28 from hand searching of reference lists, 58 from pharmaceutical company submissions, and 32 from PreMEDLINE.

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