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Prescription Treatments for Melasma. The increase in risk was observed in year one and persisted. Differences between groups became apparent in the first year of treatment. In postmenopausal women, a significant proportion of the circulating estrogens exist as sulfate conjugates, especially estrone sulfate, which serves as a circulating reservoir for the formation of more active estrogens. Adding a progestin to estrogen therapy has been shown to reduce the risk of endometrial hyperplasia , which may be a precursor to endometrial cancer. In patients with pre-existing hypertriglyceridemia, estrogen therapy may be associated with elevations of plasma triglycerides leading to pancreatitis and other complications. Estrogens act to reduce the elevated levels of these hormones seen in postmenopausal women.

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