Achieving long-term continuance of menopausal ERT/HRT: Consensus opinion of The North American Menopause Society

Objective: Estrogen replacement therapy (ERT, defined as estrogen alone) or hormone replacement therapy (HRT, defined as estrogen plus some form of progestogen) may be beneficial for many women as they approach menopause and beyond. If hormones are indicated for some women, optimal continuance is a clinical goal. The North American Menopause Society (NAMS) has developed a consensus opinion on how best to achieve this goal. Design: NAMS held a closed conference of experts in the field to determine why women who begin ERT/HRT stop taking the medication, to review what has been learned from continuance research in other therapeutic areas, to make recommendations about how to help women achieve long-term continuance of therapy, and to suggest areas for research. The proceedings of the conference were used to assist the NAMS Board of Trustees in developing this consensus opinion of the Society. Results: On the basis of current knowledge, the experts and NAMS established the following recommendations for helping women achieve long- term continuance of ERT/HRT: (1) involve the woman in the decision-making process, (2) explain benefits and risks with clarity and personalize them, (3) clarify and discuss the woman's preferences beginning early in decision making and use these preferences to modify a regimen to improve continuance, (4) provide educational information that the woman can understand, (5) help the woman systematize medication taking, and (6) follow up with the woman. Areas of needed research were identified. Conclusions: As with all long-term prescription therapies, ERT/HRT for menopause-related effects is associated with suboptimal continuance. Many techniques can be used to help improve continuance. However, more research is needed to help women achieve optimal success.