[The rationalization of the follow-up of hormonal replacement treatment in menopause]

Decision making about the opportunity of starting or continuing hormone replacement therapy (HRT) in menopause should rely on an overall evaluation of its risks and benefits for the women's health; the evaluation of HRT cost-benefit ratio, however, should include its possible outcomes from an economical point of view. In this view, and with the certainty that menopausal patients should be protected by proper treatments, our case series has been evaluated in order to improve the quality of our clinical schedules for both their access to HRT and the treatment follow-up.

Two groups of patients have been considered the first one consisted of 560 women observed during '97 for climacteric symptoms and candicated to begin HRT. The second one consisted of 100 women on HRT for 1 to 6 years. In the first group we considered which test and with which frequency were responsible for stopping or delay the beginning of therapy; while in the second group we evaluated the reasons for stopping treatment.

On the basis of our experience, the exams required before starting HRT seem to be the following: patient history, mammography, densitometry and endometrial sample as well as the parameters of glucose lipidic, coagulative and hepatic metabolism. Densitometry is useful in the annual follow-up only in patients with bone alterations from the beginning. The same exams seem required for the follow-up, with the exception of bone densitometry which should be performed yearly only in patients with bone demineralization.