The risk–benefit ratio of traditional postmenopausal hormone therapy is considered by many to be unacceptable.
Low-dose oestrogen–progestin therapy (oral or non-oral and continuous or pulsatile) may have a better risk–benefit ratio, but this remains unproven.
Steroids with selective tissue activation, such as tibolone, alleviate symptoms and protect against bone loss, but long-term safety data are lacking.
Selective oestrogen receptor modulators (SERMs), such as raloxifene, prevent bone loss when used alone, and may soon be combined with oestradiol to treat symptoms and prevent osteoporotic fracture. Effects of SERMs on the cardiovascular system are currently being evaluated.
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