LONG-TERM COMPLIANCE OF CONTINUOUS COMBINED ESTROGEN AND PROGESTOGEN REPLACEMENT IN POSTMENOPAUSAL WOMEN

The occurrence of uterine bleeding usually associated with hormonal re placement therapy is not acceptable for many women. Our objective was to review data on compliance and bleeding patterns in 70 postmenopausa l women on oral replacement with estradiol 2 mg, estriol 1 mg, and nor ethisterone acetate 1 mg daily administered in a continuous combined f ashion to avoid withdrawal bleeding. After 1 year, compliance was 97%, after 5 and 9 years 76% and 58%. The most common reason for discontin uation was spotting. Reproductive history, body weight and pretreatmen t estradiol and FSH concentrations were not different between the subg roups with bleeding - 19% - and without bleeding - 81%. The probabilit y to maintain amenorrhoe on HRT did not increase with the length of th e postmenopausal interval or weight. Endometrial histology revealed on e case of a highly differentiated in situ adenocarcinoma of the endome trium. In the women with bleeding, induced serum estradiol levels were significantly higher and pretreatment SHBG-levels lower compared to t he non-bleeders. Whether these findings may be significant for electio n of patients for continuous combined HRT remains to be determined. In conclusion, we demonstrate that adherence to this treatment regimen a pparently provides a choice patients considering long-term HRT should be informed about. However, the lack of parameters to elect patients i n conjunction with the problem of uterine bleeding does not permit the recommendation to regard continuous combined HRT as first line therap y for long-term HRT. Criteria need to be developed when to obtain an e ndometrial histology once uterine bleeding occurs, as the optimal surv eillance of this mode of HRT is presently unknown.