Moderation of the daily dose of HRT: benefits for patients.
BACKGROUND
Hormone replacement therapy (HRT) has many benefits yet compliance rates remain low. One of the main reasons for discontinuing therapy is hyperestrogenic side effects which may be dose related, and the initiation of treatment is critical to a patient's chances of gaining long-term benefits. The introduction of low dose HRT means that physicians have an option to initiate or titrate patients to a low dose. The purpose of this review is to examine current literature on the benefits for patients of low dose HRT.


RESULTS
Low dose estrogen (25 mcg/day transdermally or 0.3 mg/day orally) are effective in controlling postmenopausal symptoms, reducing bone loss and reducing cardiovascular risk factors. Low dose therapy is also effective at reducing vasomotor symptoms in highly symptomatic women. In one study, patients on a daily dose of 25 mcg estrogen experienced an 86% reduction in vasomotor symptoms compared to a 55% reduction in patients on placebo. In addition, many adverse events related to estrogens were reduced using a low dose.


CONCLUSIONS
Compliance with traditional doses of HRT is currently a problem for many women who may stop taking therapy because they experience hyperestrogenic side effects. Low dose HRT is effective at reducing vasomotor symptoms and controlling symptoms even in highly symptomatic women. Hyperestrogenic side effects may be reduced by initiating treatment at the lowest dose and titrating upwards if necessary. This may have benefits for patients in terms of offering effective control of symptoms whilst minimising hyperestrogenic effects.
Schneider
H P
HP
Universitatsfrauenklinik, Munster, Germany.
Gallagher
J C
JC
D000279:Administration, Cutaneous; D000284:Administration, Oral; D004958:Estradiol / Q000008:administration & dosage; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D004967:Estrogens / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008593:Menopause; D010349:Patient Compliance
D004967:Estrogens; D004958:Estradiol