Correspondence (reply): In Reply

It is entirely correct to say that osteoporosis is one of the health risks in women after the menopause and should therefore be treated. It is rare in perimenopausal women and does not cause the classic problems associated with the climacteric (vasomotor complaints, vaginal atrophy). Treating these problems was the main focus of our article. Several methods are available to treat osteoporosis (see “AWMF S3-Leitlinie Prophylaxe, Diagnostik und Therapie der Osteoporose bei Frauen ab der Menopause, bei Männern ab dem 60. Lebensjahr” [S3 guideline on the prophylaxis, diagnostic evaluation and therapy of osteoporosis in postmenopausal women and men aged 60 or older]), so that hormone therapy with estrogens for the treatment of osteoporosis can be recommended only where these methods are contraindicated. The most recent evaluation of the WHI study showed that after a mean follow-up of 11.8 years, the incidence of breast cancer is lowered for a mean duration of monotherapy with estrogen (ET) of 5.9 years (hazard ratio 0.77, 95% confidence interval 0.62 to 0.95, P=0.02) (1). The Million Women Study, however, found an increase in the incidence of breast cancer resultant to ET, so that the real situation cannot be evaluated conclusively from the existing data (2). ET can be given only to women who have had hysterectomies; in most women, combined estrogen-gestagen therapy is required, which leads to an increase in the risk of breast cancer after long-term use (>3–5 years) (3).