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Women's concerns with hormone replacement therapy--compliance issues
1Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710.
Objective:
To review the literature and attempt to define patient compliance with hormonal replacement therapy and physician prescription of these therapies.
Design:
Review of selected literature.
Setting:
Population studies and clinical trials.
Patients:
Postmenopausal and postcastration women.
Interventions:
Hormone replacement regimens.
Main Outcome Measures:
Descriptions and compliance by patients.
Results:
In addition to the effective control of vasomotor hot flushes and atrophic genital changes in postmenopausal women, it is now well established that the long-term use of estrogen replacement therapy (ERT) or hormone replacement therapy (HRT) with estrogen and/or progestin offers prophylaxis against osteoporosis and cardiovascular arteriosclerotic disease, notably myocardial infarction. However, despite such documentation of benefit, it is estimated that < 20% of postmenopausal women in the United States have ever had ERT or HRT prescribed, < 40% of those for whom such treatment has been prescribed will continue it after 1 year, and that overall, > 70% of those for whom it has been prescribed are not compliant. It appears that this lack of prescription and compliance are the function of both physician and patient considerations. This paper presents reasons for such actions and reviews ways in which use can be improved.