ABSTRACT
Compliance or adherence to therapy presumes knowledge by the patient and the prescriber of an optimum length of time for therapy. This knowledge only comes from an understanding of the best scientific evidence available to date and an individualization of this evidence to the particular woman’s risk factors, needs and wishes. Clearly it also requires informed consent. Thus, on the basis of the available long-term observational studies and the short-term randomized controlled trials conducted to date, compliance to therapy may currently be generalized as being appropriate for the control of menopausal symptoms for 5-10 years, for the management of low bone density over 15-20 years, and for those with cardiovascular risk factors perhaps for 25 years or more. The debate about breast cancer risk continues but current overviews are reassuring, with any increased risk with long-term therapy likely to be relatively small if any at all 1 , 2 . Indeed, the largest cohort study published to date shows a significant 16% reduction (relative risk 0.84, 95% confidence interval 0.75-0.94) in breast cancer fatalities among post-menopausal women who had ever used estrogen replacement therapy compared to non-users 3 . This study of 422 373 women over 9 years will do much to improve compliance. A family history of dementia may also prove in the future to be an indication for longer compliance. However, without long-term randomized trials it will not be possible to clearly define the optimal length of therapy for any individual, and all governments should be encouraged to fund and conduct such trials.
