Moderation of the daily dose of HRT: benefits for patients

Introduction: Hormone replacement therapy (HRT) has many benefits yet compl iance rates remain low. One of the main reasons for discontinuing therapy i s hyperestrogenic side effects which may be dose related, and the initiatio n of treatment is critical to a patient's chances of gaining long-term bene fits. The introduction of low dose HRT means that physicians have an option to initiate or titrate patients to a low dose. The purpose of this review is to examine current literature on the benefits for patients of low dose H RT. Results: Low dose estrogen (25 mcg/day transdermally or 0.3 mg/day oral ly) are effective in controlling postmenopausal symptoms, reducing bone los s and reducing cardiovascular risk factors. Low dose therapy is also effect ive at reducing vasomotor symptoms in highly symptomatic women. In one stud y, patients on a daily dose of 25 meg estrogen experienced an 86% reduction in vasomotor symptoms compared to a 55% reduction in patients on placebo. In addition, many adverse events related to estrogens were reduced using a low dose. Conclusion: Compliance with traditional doses of HRT is currently a problem for many women who may stop taking therapy because they experien ce hyperestrogenic side effects. Low dose HRT is effective at reducing vaso motor symptoms and controlling symptoms even in highly symptomatic women. H yperestrogenic side effects may be reduced by initiating treatment at the l owest dose and titrating upwards if necessary. This may have benefits for p atients in terms of offering effective control of symptoms whilst minimisin g hyperestrogenic effects. (C) 1999 Elsevier Science Ireland Ltd. All right s reserved.