Can we improve compliance with long-term HRT?

In order to increase awareness of strategies to prevent osteoporosis and heart disease we designed a clinic offering education and screening to all women aged 40-60 years on our practice list of 8600 patients, starting in January 1988. Screening and supervision of HRT users occurred at a weekly clinic run by the doctor and nurse. Audit in August 1991 showed that there were 260 present users of HRT (20%) of our population of 1322 women aged 40-60 years. Seventy-eight percent had taken HRT for over a year and 15% for more than 5 years. Ex-users totalled 117, of whom 52% had taken HRT for over a year and 14% for over 5 years. Examination of the clinic registers and responses to postal questionnaires showed that 681 (51.5%) of patients attended the health education clinic. Of the clinic attenders, 25% took HRT compared with 10.8% of non-attenders. Compliance with long-term therapy measured by audit of repeat prescriptions varied between 84% and 92% over a period of 5 years. Reasons for stopping treatment were anxiety over possible side-effects, especially breast cancer and dislike of bleeding.