Introduction

Schiff: As clinicians whose practices include large numbers of peri- and postmenopausal women, all of us on this panel are accustomed to counseling women about hormone replacement therapy [HRT]. While we may talk to them about its long-term preventive benefits and risks, usually their immediate concern is relief of symptoms—a short-term but very important goal. We know that estrogen is effective in providing that relief, but we also know that its effectiveness depends on continued and correct use. Unfortunately, continuance and compliance are less than optimal for HRT. Of the women who agree to take HRT, 20% never fill that first prescription, and only 20% of those who do begin taking postmenopausal hormones stick with their regimens beyond 2 years.¹,² In contrast, the continuance rate for prescribed medications is 75%.³ In this discussion, I’d like to focus on why that is so and what we can do about it, particularly in the critical initial period of use.

Dr. Berga, I’m going to turn to you first. To start, let’s talk about the event that most commonly brings a woman to your office to talk about HRT—the hot flush.