ABSTRACT
For many years hormone replacement therapy (HRT) has been a recognized and accepted treatment in ameliorating the unwelcome consequences of the menopause. Unfortunately, studies have shown that about 50% of women who start HRT discontinue within 1 year1. It has been reported that patients are more likely to discontinue therapy if they experience side-effects related to treatment, and are more likely to continue if side-effects are less common2. Women with an intact uterus need progestin administration whenever estrogen replacement therapy (ERT) is used; this avoids endometrial hyperplasia and neoplasia3,4. Cyclical administration of progestin causes withdrawal bleeding, which leads to decreased compliance5. In many studies, the dislike of the withdrawal bleed is a major factor in women avoiding or discontinuing HRT6-8. In addition to the scheduled bleed, women on cyclical HRT also have a higher incidence of abnormal vaginal bleeding compared with non-HRT users. This results in a greater number of gynecological investigations in these women, which further reduces compliance9. Other factors cited as reducing compliance include mastalgia, weight gain, fear of cancer, and symptoms of pre-menstrual syndrome10.
