SUMMARY

* Relatively few postmenopausal women choose to use hormone replacement therapy (HRT). Many who do use it discontinue therapy after a few months. The main reasons for this are withdrawal bleeding and the fear of breast cancer. Many women remain unaware of the possible benefits of using HRT (see MeReC Bulletin Vol. 8 No. 3).

* Recently, several new HRT preparations have come to market, including oral preparations containing non-androgenic progestogens, continuous combination regimens and novel transdermal delivery systems.

* Using a less androgenic progestogen, such as medroxyprogesterone acetate or dydrogesterone, may reduce the incidence of androgenic effects such as acne or greasy skin. Fixed-dose combination products may encourage compliance, although dosage adjust-ment of the individual hormones is only possible by prescribing oestrogen and progestogen separately, or by using combination packs with varying strengths.

* Continuous combination HRT may be a useful alternative in women who are at least one year past the menopause. Withdrawal bleeding is eventually eliminated in most women; however, irregular bleeding is common in the early treatment phase. Data on the effects of continuous HRT on hip fractures, heart disease and breast cancer are lacking. It is considerably more expensive than many sequential regimens.

* Oral regimens are well tolerated by many patients and are an appropriate first choice. Although they are more expensive, transdermal regimens may be suitable for some women. The thinner and less obtrusive matrix patches may make this route more acceptable to women.