Compliance with hormone replacement therapy in Thai women

A retrospective study was performed to determine the compliance of hormone replacement therapy (HRT), the characteristics of women who continue to use HRT and the reasons for discontinuation. This study comprised of 821 postmenopausal women who attended the menopause clinic between January 1993 and December 1997. A total of 613 women (74.67%) were considered to be good compliant users. They had been on HRT for at least 1 year. Two hundred and eight women (25.33%) discontinued the treatment, with an average of 5.1 months duration of use. The younger age group at time of consultation and at menopause and those with previous hysterectomy were factors associated with higher degree of compliance. Its compliance decreased with age and the duration of menopause. The common reasons in the women's decision to discontinue HRT were bleeding episodes (23.08%), undesirable side effects (15.05%) and on physicians' advice (13.46%), respectively. Compliance with HRT appears to be similar to that reported in other specialist centres. Factors affecting compliance were age, age at menopause, duration of menopause, and hysterectomy. Irregular vaginal bleeding was the major reason for discontinuation.     

Compliance with hormone replacement therapy in Chinese women in Hong Kong

Compliance with hormone replacement therapy (HRT) has been extensively studied in western countries. However, there is little data concerning women in Asian countries. A retrospective study was performed to determine compliance in a group of Hong Kong Chinese women who commenced HRT over a 2 year period. Two years after the commencement of HRT, 68.3% were still taking HRT, although not always in the original formulation. The highest drop out rate occurred during the first 6 months. Factors which were associated with a higher degree of compliance were young age at menopause and at the time of initial consultation and the use of unopposed HRT. A number of significant medical problems were identified during the 2 years of follow up which may have remained otherwise undetected. Compliance with HRT appears to be comparable to that reported in other western specialist centres. Nearly 9% of women who stopped HRT did so because other doctors told them that they did not need the treatment and another 6.5% because of the fear of breast cancer.     

Compliance with long-term oral hormonal replacement therapy

Objective: To study long-term compliance with oral hormonal replacement therapy (HRT). Methods: A total of 151 early postmenopausal women were initially randomly allocated to three groups in a double-blind, placebo controlled trial. Fifty women received continuous combined therapy, another 50 were placed on sequential therapy, while the remaining 51 women were given placebo for 2 years with no subsequent therapy. After 2 years of the trial, the women were followed in an open investigation for a total of 8 years. Results: After 8 years, 112 (85%) women were interviewed. None of the women in the combined group had changed to other therapies (46% were still in treatment), 32% were still being treated with sequential therapy and 18% had changed to other HRTs (mainly because the women disliked the monthly bleeding induced). Of the placebo group, 18% had started HRT while 53% still did not receive any therapy. Of the women who had taken combined therapy for 5 years, 95% were still in therapy at the 8-year stage. Of the 25 women who had taken sequential therapy for 5 years, 52% continued until the 8-year stage and a further 16% received other types of HRT. The women who changed HRT switched to continuous combined therapy. Conclusion: The continuous combined treatment might provide an alternative to sequential treatment in postmenopausal women to achieve high long-term compliance.     

Compliance with 10 years oral hormonal replacement therapy

OBJECTIVE: To study 10 years compliance with oral hormonal replacement therapy (HRT). METHODS: One hundred and fifty-one early postmenopausal women were initially randomly allocated to three groups in a double blind, 2-year placebo controlled trial. Fifty women received continuous combined therapy, 50 were placed on sequential therapy, while the last 51 women were given placebo for 2 years and after that no therapy. After the trial, the women were followed in an open investigation for a total of 10 years. RESULTS: One hundred and twenty-six women (83%) out of 151 came to a 10-year interview, 4% had died and the remaining did not want to participate. None of the women in the combined group had changed to other regimens (42% were still in treatment after 10 years). Twenty-four percent from the original sequential group were still in sequential therapy; another 24% of the group had changed to other HRTs (mainly because the women disliked the monthly bleedings). Fifty-three percent of the women from the placebo group had not received any HRT. Eighteen percent were on HRT. Eighty-seven percent of the women who had taken combined therapy for 8 years were still being treated at the tenth years' visit. CONCLUSION: Long-term compliance was excellent for continuous combined therapy and better than for sequential after 10 years.     

Compliance with oral theophylline therapy in asthmatic children

Serum theophylline levels were obtained from 111 children on continuous theophylline therapy when seen in the emergency department for acute episodes of wheezing. Sixty-six percent of patients were at least partially compliant and only 34% were noncompliant in medication taking on the basis of a serum theophylline level of less than 5 micrograms/mL. The main factors associated with compliance were type of primary care source, whether the patient had difficulty keeping appointments, and the relationship of the caretaker to the patient.     

Growth hormone therapy

Growth hormone therapy with rhGH (recombinant human growth hormone) has been recommended for treatment of GH deficient short stature in children, repeated hypoglycemias in infancy and early childhood due to GH deficiency, short stature accompanying chronic renal failure prior to renal transplantation and Turner's syndrome. It is now increasingly recommended to adults with GH deficiency following pituitary tumour surgery or irradiation or idiopathic hypopituitarism. There are other indications for its use where evidence for protein catabolism is very strong such as burns injury. The end points of GH therapy in children include achievement of desirable adult height or a growth rate velocity of < 2.5 cm/year. In adults GH deficiency, GH therapy is intended for improvement of general well being, body composition and metabolic markers of GH function.     

Disturbances of endometrial bleeding with hormone replacement therapy

Breakthrough bleeding is a common problem in postmenopausal women taking hormone replacement therapy (HRT) and is often the single most important factor deterring women from continuing to use HRT, or from starting it in the first place. The mechanisms which underlie this unscheduled bleeding are poorly understood. The benefits of HRT in terms of longevity and quality of life are becoming increasingly apparent, and a greater understanding of why this bleeding occurs and how we can prevent or treat it, will undoubtedly enable more women to reap the potential considerable benefits of long-term oestrogen and progestogen replacement. What sets postmenopausal women apart from their counterparts in the mid-reproductive years is the increased likelihood of endometrial adenocarcinoma in which unscheduled bleeding is the presenting symptom. Therefore, spontaneous postmenopausal bleeding must always be appropriately evaluated. Hence, the occurrence of unscheduled bleeding with HRT may provide a dilemma with diagnosis as well as a challenge to acceptability. Combined HRT regimens tend to be predominantly progestogenic, and there is increasing evidence to suggest that some of the vascular changes seen in women taking long-term, low-dose progestogen-only contraceptives may also occur in women taking HRT.     

Practice patterns with hormone therapy after surgical menopause

Objectives

The aim of this study was to examine hormone therapy (HT) users’ experiences, perceptions and information sources in 2009.

Study design

Questionnaire survey was conducted in 2009 among women using HT. The questionnaire (n = 500) was distributed from pharmacies across Finland. The response rate was 58% (n = 281).

Main outcome measures

The survey measured self-reported benefits and adverse reactions, fears and information sources.

Results

The number of systemic HT users reporting fears was 50% (n = 99). The most common fear was breast cancer (27%). Systemic HT users who had considered discontinuation of HT or had temporarily discontinued HT experienced fears more often than other respondents (p < 0.001 and p = 0.029). The most common source of information on the benefits of HT in both surveys was a physician (91%), whereas the most common source of information on adverse reactions was the media (54%). Vaginal HT users had experienced similar fears as users of systemic HT.

Conclusions

Women using HT need more information about the risks of HT from their physician. This is especially important for women who are not able to manage the symptoms without HT, but have tried or considered discontinuation and for vaginal HT users.     

Intranasal hormone replacement therapy

Although the optimal route of delivery for hormone replacement therapy has not yet been determined, desirable qualities would include good efficacy, easy administration, minimal side effects, and optimal therapeutic profile. This would potentially serve to improve patient compliance and satisfaction. The intranasal route has been evaluated for the administration of menopausal hormones and seems to fulfill these requirements. The intranasal route would also seem to be a viable alternative for drugs that are poorly absorbed after ingestion by avoiding hepatic first-pass elimination. The intranasal route is, therefore, innovative for the delivery of natural sex steroids in postmenopausal women receiving hormone replacement therapy. Early studies demonstrate that it is safe, effective, and acceptable to postmenopausal women. In addition, the nasal administration of a combination of estradiol and progesterone would seem to be an attractive way to deliver hormones to nonhysterectomized postmenopausal women. Providing alternative routes of administration may also enhance compliance.     

Sex hormone replacement therapy for individuals with Turner syndrome

Turner syndrome is a relatively common genetic condition resulting from absence of all or part of the second sex chromosome. Individuals with Turner syndrome commonly exhibit cardiovascular, endocrine, renal, reproductive, and/or psychosocial abnormalities, among other conditions. Most girls with Turner syndrome have hypergonadotropic hypogonadism and therefore need sex steroid hormonal replacement therapy. The optimal estrogen replacement treatment regimen to induce pubertal development is still being determined. The goals of the estrogen replacement are to mimic the normal physical and social development for timing and progression of puberty. Treatment should begin at 11–12 years of age, with dose increases every 6 months over a 2–3 year period. Initiation with low doses of estrogen is crucial to preserve growth potential. On the other hand, delaying estrogen replacement may be deleterious to bone and uterine health.     

Growth hormone deficiency and growth hormone therapy in Ullrich-Turner-Syndrome

Summary In a girl with Ullrich-Turner-Syndrome (gonadal dysgenesis 45, XO) and growth hormone deficiency, 10 U of human growth hormone/m² body surface area/week increased the growth rate from 2.0 to 4.1 cm/year. Doses of up to 36 U/m²/week did not improve the growth rate in 4 girls with Ullrich-Turner-Syndrome who had normal plasma growth hormone concentration and incretion. We conclude that growth hormone therapy is unsuccessful in dwarfism in Ullrich-Turner-Syndrome and should be reserved for patients with proven growth hormone deficiency.Supported by Deutsche Forschungsgemeinschaft, SFB 51/C10     

The hormone replacement therapy controversy

Summary The issue of hormone replacement treatment for menopausal symptoms, osteoporosis, various cardiac problems, and other disorders has received a great deal of attention. Recent data concerning the benefits and risks have changed ideas about indications and contra-indications. In this paper we will consider the multiple factors that determine an individual woman's decision about taking or continuing to take hormone replacement therapy, not only the medical indications. We will discuss the established benefits of replacement therapy, conditions for which the benefits are not established, areas of controversy, risks of treatment, and factors underlying the decisions about undergoing the treatment.     

Perspectives in hormone replacement therapy

Estrogens have been convincingly shown to be highly effective in preventing and reversing menopause-related conditions, such as hot flushes, urogenital complaints, and postmenopausal bone loss. Observational studies report that long-term, estrogen-containing, postmenopausal hormone replacement therapy (HRT) leads to a substantial reduction in hip fractures, myocardial infarction, and possibly colonic cancer, with important consequences for health and quality of life. Estrogen replacement may postpone the onset of Alzheimer's disease and extend life. While many of these effects are biologically plausible, with a variety of cellular mechanisms being involved, only ongoing and future large-scale randomized clinical trials can and should define the effects of HRT more precisely. Long-term compliance is a key issue for long-term benefits, and offering women a choice of administration routes and regimens can only be beneficial in this respect. Pills, patches, gels, and implants are all widely prescribed. Intravaginal or intranasal forms of administration, which are very easy to use and adaptable on an individual level, are among the new options which could improve long-term continuation of HRT use. Fear of breast cancer and recurrence of vaginal bleeding are real concerns for many women considering HRT. This has led to research into lower-dose, estrogen-containing regimens, into continuous combined regimens, and into the potential of estrogen receptor alpha or beta binding molecules that may help to prevent such problems from arising. The prospects for safe and effective postmenopausal HRT with either estrogens or estrogen-like drugs are very promising when these drugs are used in a patient-tailored, risk profile-based manner.