'PROFOX'--the post HRT nightmare.

The recent report of a two-fold increase in esophageal cancer in women taking oral bisphosphonates is yet another reason to question current relegation of hormone replacement therapy (HRT) to a minor role in the correction of many problems occurring in the younger postmenopausal woman. Women under the age of 60 years with low bone density, flushes, sweats, vaginal dryness, loss of libido and climacteric depression would be treated with estrogens by gynecologists and most general practitioners. It is regrettable that bone physicians use bisphosphonates as first-line therapy in this age group, in spite of the growing number of serious complications reported. Similarly, psychiatrists have little experience in the use of estrogens for the reproductive depression syndrome of postnatal depression, premenstrual depression and perimenopausal depression, but use antidepressants. The adverse effects reported in the 2002 Women's Health Initiative study are given as justification for not using estrogens, although serious complications did not occur in women starting HRT before the age of 60 years. But, in reality, the objection to estrogens from psychiatrists and bone physicians preceded this study by decades and was a result of their unfamiliarity with this treatment. Regrettably, PROFOX (PROzac + FOsomaX) will become an established treatment for women who really need estrogens.