A PRACTICAL GUIDE TO PRESCRIBING HORMONE REPLACEMENT THERAPY

Over the past 20 years there has been increasing interest in the menop ause and hormone replacement therapy (HRT). More recently, postmenopau sal HRT has been seen as a specific treatment for symptoms in the shor t term and preventative therapy in the long term. Women must be counse lled regarding the risks and benefits of HRT according to the best ava ilable evidence. The patient should also be actively involved in the d ecision regarding HRT therapy, which should then improve patient compl iance. Generally, an appropriate regimen of HRT can be formulated for the majority of patients. Progestogen should be added to therapy in wo men with an intact uterus in a cyclical or continuous regimen. The man agement of common estrogenic and progestogenic adverse effects is impo rtant in improving compliance. At present, new drugs are being develop ed for the management of the menopause (selective estrogen receptor mo dulators and phytoestrogens). Obviously, further research will be nece ssary to determine whether these drugs have advantages over regular HR T. By offering postmenopausal women HRT an attempt is made to optimise their physical and psychological well-being. However, HRT is not with out adverse effects, the most worrying of which is the possible increa se in breast cancer risk with longs term use. However, with patient ed ucation efforts, treatment regimens acceptable to both patient and pra ctitioner can be initiated; in this regard, the aim of the practitione r should be to help the menopausal woman make the decision which is th e most appropriate for her.