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An Alternative Regimen of Hormone Replacement Therapy to Improve Patient Compliance
Author(s) -
Kemp John F.,
Fryer Judith A.,
Baber Rodney J.
Publication year - 1989
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1989.tb02880.x
Subject(s) - medicine , regimen , hormone replacement therapy (female to male) , endometrial cancer , progestogen , hormone therapy , radiation therapy , endometrial hyperplasia , carcinoma , surgery , gynecology , cancer , breast cancer , estrogen , testosterone (patch)
EDITORIAL COMMENT: There is no doubt that the introduction of progestogen to regimens of oestrogen replacement therapy for menopausal women, because of the risk of endometrial carcinoma from unopposed oestrogenic stimulation of the endometrium, has had one very unfortunate result — many patients resent the return of menstruation and discontinue hormone therapy. Indeed having been warned about the risk of carcinoma, patients often fear that the return of bleeding heralds such a complication. This paper reports good patient compliance with a regimen aiming at 6‐monthly cycles. Annual endometrial sampling revealed no cases of carcinoma. Although this regimen warrants further study before endorsement, the authors have highlighted the need to judge regimens of hormone replacement therapy in terms of patient compliance as well as risks of endometrial hyperplasia and carcinoma. Summary: In order to achieve the long‐term benefits from hormone replacement therapy of a markedly reduced incidence of heart disease and osteoporosis, a high degree of compliance is essential. In an effort to obtain high compliance, it was decided to introduce a cyclic therapy of 6 months duration using conjugated oestrogens supported by a 10‐day course of progestogens. A total of 85 patients were treated prospectively. Compliance was assessed by the number of patients continuing treatment, and endometrial response was assessed by office biopsy and cytological or histological examination. Five patients withdrew, giving an overall compliance rate of 94%. Two have subsequently resumed therapy, thus 98% of those enrolled are currently receiving hormone replacement therapy. No cases of endometrial carcinoma were detected during the trial period of 4 years. Two cases of mild atypical endometrial hyperplasia were detected but both were mild and reverted to secretory or inactive endometrium following progestogen therapy. This regimen provides a viable alternative for those women who are troubled by progestogenic side‐effects and monthly withdrawal bleeding.