Compliance with estrogen replacement therapy: current issues.

Abstract

Compliance is now considered to be a major issue in the clinical arena of the menopause and hormone replacement management. Recently, the terminology has evolved to intimate a closer working relationship between the woman and her clinician, but still varies from country to country, as do uptake and continuation rates. The literature is conflicting, some papers demonstrating an improvement in the situation in recent years, others striking a more pessimistic note. Certainly, trends can be identified. Factors are emerging that will positively influence long-term adherence, and most studies are consistent in the reasons women quote for cessation of therapy. The gulf between medical and feminist literature is wide, but we should examine women's viewpoints to enhance the profession's understanding of why the perception is one of unnecessary medicalization. Market research allows an insight into women's requirements and we should learn from other countries, cultures and professions. There is an increasing emphasis on communication skills. Counselling and information-giving have been recognized to be the key to developing a working relationship with the patient, but education for the physician is also necessary if accurate, individualized risk-benefit assessments and patient profiling are to be effective. Finally, a wider range of treatment options enhance individualization for the woman.