Foreword by Isaac Schiff, MD

In recent years, hormone replacement therapy [HRT] has increasingly been promoted for its long-term benefits as preventive care for osteoporosis, cardiovascular disease, and perhaps old-age dementia. Nevertheless, its primary use has continued to be short term, for relief of menopausal symptoms such as hot flushes and vaginal atrophy. In either case, continuance is perhaps the biggest obstacle to optimal effectiveness. Motivating patients to continue hormone therapy long term is daunting, but even in the short term, the record for continuance is discouraging. Studies suggest that within 2 years after starting a postmenopausal hormone regimen, about 80% of women stop using it.¹ As many as 20% of women don’t even fill their prescriptions after the first visit.²

Since the evidence available to us strongly suggests the benefits of HRT significantly outweigh its risks for most postmenopausal women, particularly in the short term, it is a major loss that so many patients discontinue their hormone therapy before giving it a chance to work properly. The average continuance rate for prescribed medications is 75%.³ Why is adherence a bigger problem for HRT than for other therapies? Could we be more effective in educating women about HRT? Are patients getting information from somewhere else that is causing them to abandon or reject hormones? What can we do to ensure that they continue therapy if we feel it is in their best interest? Are there regimens that are more conducive to good adherence and less likely to cause side effects?

To answer these and other important questions, we have assembled a panel of three experts recognized for their knowledge of menopausal issues and their clinical experience in caring for peri- and postmenopausal women. I hope you will take advantage of this opportunity to join us in exploring this topic. I’m confident our panelists’ insights will prove especially helpful to you in guiding your patients through the crucial first stages of hormone therapy so that they will continue on to receive its full benefits.