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Recent studies concerning the relationship of exogenous estrogens and endometrial cancer have been reviewed, and the objections to their conclusions discussed. Even considering the most serious of these reservations, it is difficult to avoid the tentative conclusion that estrogens are causally linked to endometrial cancer, and that the attributable risk is numerically sizable. Whether the medical costs will be ultimately shown to outweigh the benefits of estrogen replacement therapy will depend largely on whether or not a relationship to breast cancer is shown, and on the magnitude of the effect of estrogens in preventing serious complications of ovarian failure. For the time being, estrogenic treatment of menopausal symptoms should be as brief as possible, should use the lowest dose possible, and should probably be given in cyclic fashion, particularly to women in intact uteruses. Every attempt should be made to give patients a quantitative understanding of both potential risks and benefits before they decide for or against estrogen therapy.

The medical records of a Los Angeles retirement community were examined to find out the association between oestrogen replacement therapy and death from ischaemic heart disease. Women dying from ischaemic heart disease over a five-year period were compared with living and deceased control groups; both controls were matched with cases for date of birth, date of entry into the community, race, and socioeconomic status. The deceased control was also matched for date of death. Compared with living controls cases using conjugated oestrogens had a risk ratio for death from ischaemic heart disease of 0.43 (95% confidence interval 0.24-0.75). Comparison with deceased controls gave a similar relative risk. This association was not due to identifiable confounding factors. Other risk factors for ischaemic heart disease, including hypertension, diabetes, stroke, angina pectoris, and heavy cigarette smoking, were confirmed by this study.