[Hormone substitution in postmenopause. Administration mode, regimen and compliance]

The route of administration and the regimen are of great importance for efficacy and acceptance of hormone replacement therapy in the menopause. Steroids may be applied orally, transdermally, subcutaneously or vaginally. Due to the differences in absorption and metabolization the serum levels are very variable. Bone and heart protection are secured by either oral or parenteral application. Unopposed estrogens should be given to hysterectomized women only, except estriol. In all the other patients progestogens must be added, preferably for 10-14 days per month. Prolonged intervals of up to three months are acceptable in selected cases. A few years after menopause continuous-combines regimen may be used in order to prevent withdrawal bleeds. The choice of the method is also decisive for compliance, since side effects, particularly irregular bleedings are among the most frequent causes for discontinuation. Counseling, motivation and comprehensive care are equally important.