ABSTRACT

The benefits of estrogen replacement therapy in estrogen-deficient women have been widely documented. Such treatment relieves vasomotor symptoms, improves mental functions, prevents bone loss and reduces the risk of cardiovascular disease. Administered to women with an intact uterus, unopposed estrogen can stimulate endometrial growth, resulting in a high incidence of endometrial hyperplasia and endometrial carcinoma1,2; this can lead, in turn, to a high incidence of gynecological intervention3. It has been established that the administration of a progestogen for 10-12 days every 28 days may protect the endometrium against hyperplasia and diminish the risk for developing endometrial carcinoma. The addition of a progestogen in a cyclical manner results in the reinitiation of cyclical bleeding, which for the majority of postmenopausal women is not a welcome event, is regarded as a burden that serves little purpose, and becomes tolerable only as a price to be paid for the relief of symptoms. To promote long-term continuation with postmenopausal hormone replacement therapy (HRT), the regulation of menstrual episodes, in terms of cycle length, duration and amount of bleeding, becomes an essential clinical skill to facilitate the care of postmenopausal women. The alternative would be the administration of an amenorrheic regimen, but this is not a straightforward solution.