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Abstract
Withdrawal bleeding and other side effects such as edema, bloating, premenstrual irritability,
lower abdominal cramps, dysmenorrhea, and breast tenderness limit compliance with
hormonal replacement therapy. Although many of these troublesome side effects can
be managed by adjusting the dose or changing the source of the estrogen or progestin
components, postmenopausal women view withdrawal bleeding as the most negative factor
influencing their decision to use hormonal replacement therapy. Additionally, the
potential link between postmenopausal estrogen use and subsequent endometrial hyperplasia
and cancer concerns potential users. Cyclic progestins protect the endometrium from
hyperplastic changes but may not prevent withdrawal bleeding. Both patient and physician
education, including the nature of menopause and the protective role of estrogens
in osteoporosis and cardiovascular disease, are critical to improving compliance with
hormonal replacement therapy.
Key words
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© 1989 Mosby. Published by Elsevier Inc. All rights reserved.
