Compliance difficulties with progestin-supplemented estrogen replacement therapy

Forty postmenopausal women were studied prospectively while undergoing estrogen replacement therapy (ERT). Eighteen women with an intact uterus were cycled with additional progestin therapy. All but three women of the estrogen-progestin group elected to discontinue therapy because of undesirable "physiologic" withdrawal bleeding. Future progestin-ERT recommendations should take these results into consideration. Wide-scale re-education of patients and physicians will be necessary if the existing recommended regimens are to be observed. Alternatively, new or different pharmacologic agents and regimens will be necessary to achieve the postulated benefits of progestin-ERT without undesirable side effects.