Compliance to hormone replacement therapy.

Hormone replacement therapy (HRT) after menopause can effectively reduce climacteric-related symptoms and therefore increase quality of life. A large number of studies have also demonstrated that with a sufficient dosage bone loss can be prevented and fracture frequency reduced. Epidemiological and experimental studies also suggest a decrease in cardiovascular mortality and morbidity among HRT users compared to nonusers. From an epidemiological perspective, in order to obtain optimal prevention of osteoporosis and of cardiovascular diseases, a high proportion of postmenopausal women should be treated using long-term therapy. Surveys generally show that only a small proportion of postmenopausal women use hormone replacement therapy (in Belgium, around 14%) and that the long-term compliance to treatment, which is mandatory in the prevention due to low compliance remains unknown. The reasons why patients patients do not pursue their treatment in the long run remain unclear. Fear of cancer and drug-related side effects, such as unacceptable bleeding, have been among the most frequently mentioned causes. Thus, individual information on patients regarding HRT seems to be crucial issue. A few recent studies have suggested a favorable role of osteoporosis prevention and bone mass measurements to increase compliance, but this is not well established and will depend on the physician's attitude toward HTR and osteoporosis prevention. At present, very little is known about the physician's decision to treat postmenopausal women with HRT. Sometimes, the physician's attitude has been reported was very negative toward HRT-apparently, many physicians think HRT increases cardiovascular risk, even though most data suggest a reduction of cardiovascular risk among HRT users. Very little research has actually been performed on how to improve compliance. Education and behavioral strategies may be of use. Improved communication between patients and physicians, establishing a confidential relationship with patients, and the involvement of nursing counseling are all strategies which may improve compliance. The use of easy-to-take medication that induces no bleeding, supported by calendar devices or reminders, may facilitate chronic use of medication. Future research needs to investigate the physician's and patient's decision-making processes and the reasons for those decisions.