Handling hormone replacement therapy: key issues for the prescriber.
OBJECTIVE
To examine the key considerations for physicians when prescribing hormone replacement therapy (HRT).


METHODS
A review of the literature, including some unpublished data.


RESULTS
As far as oral HRT is concerned, relatively large doses may have to be given because of the first-pass effect involving metabolism by the liver following absorption from the G1 tract. Alternatives include percutaneous gels, impregnated pessaries, subcutaneous implants and transdermal patches. The last of these offers the possibility of delivering oestrogen accurately in convenient form and many patients regard this as a more 'natural' way of treating the menopause. Provided equivalent doses of hormone are given, all these routes of administration are equally effective in preventing osteoporosis. The situation with respect to cardiovascular disease is more complex and different types of oestrogen or progestogen and different routes of administration can have different effects on metabolic risk factors. Certain oral HRT can adversely affect glucose tolerance and insulin metabolism while transdermal HRT has very little effect.


CONCLUSIONS
The first issue for the physician is the choice of route of administration. To some extent this may depend on the patient's other clinical conditions such as raised triglycerides HRT. Patient preference is very important since this will affect compliance. One approach is to start with a fixed combination of oestrogen and progestogen which is usually easier for the patient to remember and use. Side-effects are usually due to the progestogen component. The variety of progestogens available in Europe means that switching to other combinations is not difficult if side effects occur. Patients satisfaction is the ultimate determinant.
Stevenson
J C
JC
Wynn Division of Metabolic Medicine, National Heart and Lung Institute, Imperial College, London, UK.
D050260:Carbohydrate Metabolism; D002318:Cardiovascular Diseases / Q000517:prevention & control; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D017060:Patient Satisfaction