PROGESTOGEN INTOLERANCE AND COMPLIANCE WITH HORMONE REPLACEMENT THERAPY IN MENOPAUSAL WOMEN

It is vital that we maximize compliance if patients are to receive the full benefits from hormone replacement therapy (HRT). One of the main factors for reduced compliance is that of progestogen intolerance. Pr ogestogens have a variety of effects apart from the one for which thei r use was intended, that of secretory transformation of the endometriu m, Endometrial effects vary between individuals and between different progestogens, leading to bleeding problems, Symptoms of fluid retentio n are produced by the sodium-retaining effect on the renin-aldosterone system, The nor-testosterone-derived progestogens can have adverse ef fects on skin, lipids, vasculature and insulin resistance. Negative mo od effects are produced by most progestogens due to the effect on neur otransmitters via central nervous system progesterone receptors, Manip ulation of the dosage and duration of progestogen, continuous administ ration of a low dose of progestogen and a reduction in the number of p rogestogenic episodes can be used to improve compliance, The progestog en and progesterone releasing coils and vaginal progesterone gel minim ize systemic side effects and bleeding. Adverse effects can also be av oided by making use of the progesterone receptor-specific progestogens such as the pregnanes (e.g. cyproterone), nor-pregnanes (e.g. nomeges trol) and progesterone itself, Hysterectomy remains an option for the severely progestogen-intolerant woman. In the future, progestogen into lerance may not be an issue if selective oestrogen receptor modulators provide a complete alternative to HRT.