The management of hormone replacement therapy, bleeding and compliance

Despite the overwhelming evidence that hormone replacement therapy (HRT) is effective not only in alleviating the symptoms of the climacteric, but in preventing osteoporosis and reducing the cardiovascular and cerebrovascular consequences of estrogen deficiency, it has been estimated that fewer than 3% of women receive HRT for more than 3 years and that the majority of dropouts occur within the first year. Even among practitioners, opinion is divided as to the indications, treatment modalities, duration and monitoring of hormone replacement therapy1. It has been estimated that only 9% of eligible women are taking HRT2 but, reassuringly, 75% of non-users of HRT would consider therapy if it were recommended by their doctor. It is to this group that information about the benefits of prolonged therapy should be targeted3.