Hormone replacement therapy (HRT) has been shown to be beneficial in reducing
osteoporosis and alleviating climacteric symptoms. HRT has been suggested to reduce the risk for
coronary heart disease (CHD), but data are controversial. Unopposed
estradiol therapy seems to have a favourable effect on
lipid profile and
glucose tolerance whereas addition of a
progestogen may attenuate these favourable metabolic changes. Data on HRT in women with
diabetes mellitus are scarce but of potential interest since these women are often characterised by hyperandrogenicity,
insulin resistance and dyslipidaemia and are at a high risk for developing CHD. Present evidence suggests that short term unopposed oral
estradiol therapy has a beneficial effect on
glucose homeostasis,
lipid profile and fibrinolytic activity, which may be compatible with a reduced risk for CHD. Accordingly, it may be hypothesised that HRT in women with
diabetes mellitus may be at least as beneficial as in women without
diabetes mellitus. However, women with
diabetes mellitus are at increased underlying risk for
venous thromboembolism and
endometrial cancer. Whether HRT further increases this risk is not yet clear, but this possibility must be considered. It is, however, likely that the benefits with HRT in postmenopausal women with
diabetes mellitus outweigh the risks, but randomised studies are required before any more definite risk-benefit assessment can be made long term.