Low or ultra low doses of estrogen: against the

Abstract

Denigrating the interest of low doses would be
risky in a scientific and media world that now
thinks only in terms of low dosage; but aren't there
any arguments against it?
Ultra-low doses might improve the tolerance of
HRT with proven efficacy on climacteric disorders
and better clinical observance, but in the literature
it does not show any improvement on cognitive
function or on quality of life, nor any modification
of physical force. A slight improvement of vaginal
dryness has been described with no improvement
in the frequency of sexual intercourse, desire or
orgasm. The impact on the beneficial risk of the
appearance of cancer of the breast, the endometrium or the colon, as well as cardiovascular complications, has not at the moment been shown with
low doses.
Bone protection is the main argument against. The
effect of ultra-low doses of 17b estradiol on bone
density is certain but the gain in vertebral bone mineral density is significantly lower in the groups
receiving the lowest doses of estrogen. What about
the longer term risk of fractures in particular?
There is no evidence of it with low doses.
We must put an end to the psychosis surrounding
dosage: the rule about using the lowest effective
doses is not to be questioned, but this does not prevent us from personalising the dose according to
the problem encountered, hot flushes or the risk of
osteoporosis; we can also be more permissive
about the doses administered according to the age
and the general condition of the patient.