THE IMPACT OF DIFFERENT HRT REGIMENS ON COMPLIANCE

Epidemiological data strongly suggest a substantial improvement of qua lity of life for post menopausal women using hormonal replacement ther apy (HRT). Nevertheless, reluctance of women to choose HRT is high. Va rious attempts to develop regimens with substantially better acceptanc e are being investigated. Sequential and continuous combined regimens, oral and transdermal routes of administration are available; however, no regimen nor any mode of administration has proven superior with re gard to patients' compliance. Research on the specific problems of com pliance in HRT has not yet offered solutions to the medical community about optimal conditions concerning long-term hormonal therapy. Unless metabolic profiles of the various modes of treatment are defined in l ong-term trials, general recommendations are difficult to justify. As long as the occurrence of uterine bleeding is associated with any conc ept of HRT in non-hysterectomized women, adherence has been reported t o be very low. Persisting endometrial atrophy has not been achieved by any type of HRT. New regimens not stimulating endometrial growth are essential, since women in most cultures do not accept uterine bleeding after cessation of ovarian function. Educational programs should be d eveloped to inform women about the physiology of menopause in general and the rationale of HRT. The occurrence of uterine bleeding due to th e present types of HRT needs to be specifically addressed. Risk-benefi t assessments are to be explained to patients to reach an informed dec ision on HRT, and fears of women about actual or alleged negative meta bolic impacts of HRT need to be discussed.