Efectos de la terapia hormonal con drospirenona / 17 ß - estradiol sobre los parámetros del síndrome metabólico en posmenopáusicas / Effects of hormone therapy with drospirenone / 17 ß - estradiol on the parameters of the metabolic syndrome in postmenopausal women

Evaluar los efectos de la terapia hormonal (TH) con Drospírenona (DRSP)/17 ß -estradiol (E2), sobre los parámetros del Síndrome Metabólico (SM) en pacientes postmenopáusicas. Métodos: Investigación comparativa y aplicada, con diseño cuasi experimental, de casos y controles a simple ciego, prospectivo y de campo; realizada en la Consulta de Ginecología. Hospital "Dr. Manuel Noriega Trigo". San Francisco, Estado Zulia. Venezuela. Participaron 120 mujeres separadas al azar para recibir la combinación DRSP/E2 (Grupo A) o un placebo (Grupo B). Se evaluaron los componentes del SM antes y posterior a 6 meses de haber recibido la TH. Resultados: Se encontró una alta prevalencia de SM en ambos grupos antes de recibir el tratamiento (53,3% y 48%; grupo A y B respectivamente). Posterior al tratamiento, DRSP/E2 al compararse con un placebo, redujo significativamente tanto la prevalencia del SM como el riesgo de padecerlo (21,7% versus 48,3%, OR [IC95%]= 0,29 [0,13-0,65]; p < 0.001), con reducción significativa (p< 0.001) de la hipertensión arterial, glicemia basal alterada, hipertrigliceridemia y obesidad central; además de una reducción significativa de los síntomas vasomotores, síntomas psicológicos e incontinencia urinaria (p< 0.001). En el grupo B la prevalencia del SM se mantuvo sin cambios, salvo para la glicemia basal alterada y los síntomas vasomotores y psicológicos que mostraron una reducción significativa (p< 0.001). Conclusión: DRSP/E2 (2mg/1 mg) demostró ser eficaz luego de 6 meses de tratamiento tanto para el control de los parámetros que definen al SM; con pocos y leves efectos indeseados(AU)

To assess the effects of hormone therapy (HT) with drospirenone (DRSP)/17 ß -estradiol (E2) on the parameters of the metabolic syndrome (MS) in postmenopausal patients. Methods: We performed a comparative and applied research, with quasiexperimental, case-control, single-blind, prospective and field design. The study was realized in the Gynecology consultation. Hospital "Dr. Manuel Noriega Trigo". San Francisco, Estado Zulia. Venezuela. 120 women were included, they were separated to receive either the combination DRSP/E2 (Group A) or placebo (Group B). We assess MS components before and ather 6 months of receiving HT. Results: We found a high prevalence in both groups before receiving treatment (53.3% and 48%, group A and B respectively). A ther treatment, DRSP/E2 when compared to placebo, significantly reduced both the prevalence of MS as the risk of setting it (21.7% versus 48.3%, OR [95%] = 0.29 [0.13-0.65] p <0.001), with a significant reduction (p <0.001) of hypertension, impaired fasting glucose, hypertriglyceridemia, central obesity; and a significant reduction in vasomotor symptoms, psychological symptoms and urinary incontinence (p <0.001). In group B the prevalence of MS was unchanged, except for impaired fasting glycemia and vasomotor and psychological symptoms showed a significant reduction (p <0.001). Conclusion: DRSP/E2 (2mg /1mg), proved to be effective a ther 6 months of treatment both for the control of the parameters that define the SM, with few and mild side effects(AU)

Síndrome climatérico en mujeres de edad mediana desde un enfoque médico social / Climacteric syndrome in middle-aged women from a social medical approach

Se realizó un estudio descriptivo y transversal, a fin de describir las principales manifestaciones clínicas del síndrome climatérico en 341 mujeres de edad mediana que asistieron a la consulta especializada para la atención al climaterio y la menopausia del Hospital "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero de 2009 hasta mayo de 2012. La edad promedio de las pacientes en la etapa perimenopáusica fue de 47,2 años, mientras que en las posmenopáusicas resultó ser de 49,4 años. Se aplicó la escala climatérica cubana, desde un enfoque médico social. En la posmenopausia artificial, los síntomas fueron muy molestos para 69,1 % de las afectadas; asimismo, los sofocos predominaron en 88,2 %, seguidos de las sudoraciones nocturnas en 82,7 % de ellas. La depresión y el insomnio figuraron entre los síntomas psicológicos más relevantes, con 84,7 y 78,0 %, respectivamente. La medicina natural y la terapia hormonal de reemplazo constituyeron las principales modalidades de tratamiento.

A descriptive and cross-sectional study was conducted in order to describe the main clinical manifestations of the climacteric syndrome in 341 middle-aged women, who attended the specialized care for climacteric and menopause of "Dr. Juan Bruno Zayas Alfonso" Hospital in Santiago de Cuba, from January 2009 to May 2012. The average age of patients in the perimenopausal stage was 47.2 years, while in postmenopausal women was found to be 49.4 years. The Cuban climacteric scale was applied from a social medical approach. In the artificial postmenopause, the symptoms were very bothersome for 69.1 % of those affected; also, hot flashes prevailed in 88.2 %, followed by the night sweats in 82.7 % of them. Depression and insomnia were among the most significant psychological symptoms, with 84.7 and 78.0 %, respectively. Natural medicine and hormone replacement therapy were the main treatment modalities.

Calidad de vida en mujeres menopáusica con y sin terapia de reemplazo hormonal / Quality of life in menopause women with and without hormonal replacement therapy

Antecedentes: El avance de la medicina ha incrementado la esperanza de vida al nacer y el crecimiento de la población mayor a 60 años, siendo cada vez mayor las mujeres en etapa de menopausia. Objetivo: Estudiar la calidad de vida (CV) en pacientes menopáusicas con y sin terapia de reemplazo hormonal. Método: Se estableció una investigación de tipo comparativa y aplicada, con diseño no experimental, contemporáneo transeccional y de campo, donde se incluyo una muestra de 200 pacientes con diagnóstico de menopausia. Se les aplicaron los cuestionario de CV SF-36 y el Menopause Rating Scale (MRS). Resultados: Hubo diferencias significativas (p<0,05) en cuanto al dolor físico y altamente significativas (p<0,01), respecto a los síntomas somáticos, psicológicos y urogenitales en las pacientes no tratadas vs las del grupo que recibió TRH. Conclusión: Las pacientes bajo TRH perciben una mayor CV específica respecto a las pacientes que no la reciben, presentando síntomas somáticos o psicológicos menos severos.

Background: The medicine's advance has increased the life expectancy when being born and the growth of the greater population of 60 years, being increasing the women in menopause stage. Objective: To study the quality of life (QL) in menopause's women with and without hormonal therapy. Method: An investigation of comparative and applied type was settle down, with nonexperimental, contemporary transeccional and field design, where was included a sample of 200 patients with diagnosis of menopause. To these patients was be applied a questionnaire of QL, SF-36 and the Menopause Rating Scale (MRS). Results: It was a significant differences (p<0.05) in the presence of physical pain and highly significant differences (p<0.01) respect to the somatic, psychological and urogenitals symptoms in the nontreated patients when comparing them with those who received TRH. Conclusion: Patient under TRH perceives a greater specific QL with respect to the patients who do not receive it, presenting less severe somatic or psychological symptoms.

A terapia hormonal como causa desangramento uterino após a menopausa:avaliação histeroscópica de 469 casos / Hormonal replacement therapy as cause of abnormal uterine bleedingin postmenopausal women: hysteroscopy evaluation of 469 cases

Objetivo: avaliar por meio de histeroscopia e biópsia dirigida a influência do uso da terapia de reposição hormonal (TRH) sobre o endométrio de mulheres menopausadas com sangramento uterino. Material e métodos: Foram estudadas 469 pacientes com sangramento uterino na pós-menopausa e submetidas à histeroscopia no Setor de Histeroscopia da Faculdade de Medicina do ABC (FMABC). As pacientes foram divididas em grupos: Grupo I, mulheres que faziam uso de TRH após a menopausa há mais de seis meses (n=174) e Grupo II, mulheres que nunca fizeram TRH(n=295). Para análise estatística utilizou-se o teste χ2. Resultados: os achados histeroscópicos mais frequententemente encontrados foram pólipo endometrial e endométrio atrófico tanto no Grupo I como no Grupo II. Não houve diferença significativa nos achados malignos, benignos e negativos nos dois grupos estudados. Conclusões: A TRH não influenciou os achados histeroscópicos e de biópsia de endométrio em mulheres após amenopausa.

Purpose: to evaluate by hysteroscopy the role of hormonal replacement therapy (HRT) on the endometrial findings in women with postmenopausal bleeding. Material and methods: a sample of 469 patients with postmenopausal bleeding who underwent hysteroscopy procedure at Hysteroscopy Section of Faculdade de Medicina do ABC (FMABC). The patients were divided in groups: Group I, the ones with hormonal replacement therapy (HRT) (n=174) and Group II, the ones without it (n=295). For statistical analysis, the test of χ2 was used. Results: hysteroscopy revealed in both groups the same diagnosis: endometrial polyps and endometrial atrophy. No differences were observed in the comparison of results found on the Groups Iand II for incidence of malignant, benign pathology and even for the endometrium without abnormality. Conclusions: The HRT did not influence the endometrium hysteroscopic and biopsies findings in postmenopausal women.

Riscos e benefícios da terapia de reposição hormonal (TRH) em mulheres na menopausa / Risks and benefits of hormonal replacement rherapy (HRT) in women during menopause

A menopausa e uma fase da vida em que as gonadas femininas cessam a producao de estrogenio e ocorre entao o ultimo sangramento ciclico. A idade media para ocorrencia do climaterio e de 51 anos mas, em alguns casos, ele pode acontecer precocemente decorrente de varios outros fatores.O hipoestrogenismo que ocorre nesta etapa altera consideravelmente o organismo, deixando as mulheres vulneraveis aos disturbios causadospela deficiencia de estrogenos. Esta diminuicao dos niveis hormonais pode gerar alteracoes ginecologicas e extra-ginecologicas. Uma das maneiras mais comuns utilizadas atualmente para controle desta oscilacao hormonal e o uso da terapia de reposicao hormonal(TRH), a qual ja foram agregados diversos riscos e beneficios para a sua utilizacao. Quando a opcao para reducao da sintomatologia do climaterio e o uso de suplementacao de TRH, deve-se levar em conta que todas as mulheres tem historicos medicos diferentes e que a resposta ao tratamento e individual, o que resulta na necessidade de diferentesdoses de TRH. Assim, devemos chamar atencao para o fato de que a reposicao hormonal, quando realizada, deve sempre ser individualizada, nao sendo possivel a padronizacao de qualquer tratamento utilizado. Portanto, a decisao de opcao pelo tratamento de reposicao hormonal, dependera da aceitacao da paciente, sendo que ela deve ser esclarecida sobre as consequencias da deplecao estrogenica no climaterio, seus riscos e beneficios, efeitos colaterais e contra-indicacoes da mesma.

The menopause is a moment in life where the female gonads stop producing estrogen and then occurs the last cyclic bleeding. Usually it occurs in the age of 51, but in a few cases it happens before due to many others factors. The hypoestrogenism at this time takes to many changes in women’s organism, and it makes women vulnerable to some disturbs caused by estrogens deficiency. Lower hormonal levels can lead to gynecological e non-gynecological modifications. One of the most common w ays currently used to control the hormonal levels is the Replacement Hormone Therapy, and are alreadyknown many risks and benefits related to it. When the option to reduce the symptoms of the climaterium is the Replacement Hormone Therapy, we have to pay attention to the fact that every woman has a different medical history and that the response to the treatment is individual, what results in the necessity of different doses of hormones, it should always be individualized, so it is not possible to patronize any treatment utilized.Therefore, the option for the Replacement Hormone Therapy depends on the patient acceptance, always with the explanation about consequences of the lower levels of estrogen at the climaterium, risks and benefits, side effects and contraindications.

Estetrol: desde un estrógeno fetal hasta el tratamiento de la menopausia / Estetrol: from a fetal estrogen to the treatment of menopause

Estetrol es un esferoide estrogénico sintetizado exclusivamente por el hígado fetal, que traspasa a la circulación materna por la placenta. Descrito por primera vez por Diczfalusy en 1965. Desde esa fecha se han realizado diversas investigaciones preclínicas. En los últimos años, el interés por el estetrol ha aumentado, dado el logro de su síntesis en el laboratorio y la demostración de su buena biodisponibilidad y larga vida media al administrarlo por vía oral a mujeres. Se presenta una revisión de su síntesis, metabolismo y de la información científica existente de sus diferentes efectos en los tejidos estrógeno sensibles en distintos modelos animales.

Estetrol is an estrogenic steroid synthesized exclusively by the fetal liver. It crosses over from the placenta to the maternal circulation. It was first described in 1965 by Diczfalusy and from this date onwards, several preclinical investigations have been carried out. In recent years, the interest for estetrol has been growing due to its laboratory synthesis and the demonstration of its good bioavailability together with its long half life, when administered orally to women. A review of its synthesis, metabolism and existing scientific information on its different effects on estrogen sensitive tissues, in a variety of animal models, is here presented.

Effects of non-vaginal route hormonal replacement therapy on vaginal maturation index in postmenopausal women.

Objective: To evaluate the estrogenic effect on the maturation index of hormonal replacement therapy (HRT) in postmenopausal women (PMW). Methods: The maturation indexes (MI) were evaluated based on vaginal cytology which was classified into no, low, moderate and high MI. Results: There were 70 PMW who were not on HRT evaluated for controls. There were 66%, 23%, 7% and 4% of them had no, low, moderate and high MI. There were 18 PMW who used transdermal estrogen patch or gel. It was found that 0%, 66%, 17% and 17% of them had no, low, moderate and high MI. There were 42 PMWs who were given oral hormonal tablets. It was found that 7%, 33%, 53% and 7% of them had no, low, moderate and high MI. Conclusion: Hormonal replacement therapy whether via patch, gel or oral intake resulted in changes in maturation index in postmenopausal women.

Força muscular e composição corporal de mulheres na pós-menopausa: efeitos do treinamento concorrente / Muscle strength and body composition in postmenopausal women: effects of concurrent training

A menopausa é um período de transição caracterizado por diversas mudanças na composição corporal, incluindo perda de massa magra e aumento e redistribuição da adiposidade. O objetivo deste estudo foi analisar os efeitos do treinamento concorrente (TC), aeróbio e com pesos, sobre indicadores de força muscular e composição corporal em mulheres na pósmenopausa. Participaram 18 mulheres menopausadas, com e sem terapia de reposição hormonal (TRH) e clinicamente saudáveis. Foram subdivididas em dois grupos: com TRH (n=8, idade =50,12 ± 3,8), e sem TRH (n=10, idade=56,3 ± 7,4). O TC teve duração de 10 semanas, com freqüência semanal de três dias e duração média de 60 min/sessão. Para o treinamento com pesos foram propostos nove exercícios para os principais grupamentos musculares e para o treino aeróbio, caminhadas e corridas com duração de 30 min. O treino aeróbio foi sempre realizado após o treinamento com pesos. Análise de variância (ANOVA) foi empregada para as comparações entre os grupos, para analisar os efeitos do treinamento e o post hoc de Scheffé para comparações múltiplas. Os resultados encontrados mostraram que o TC foi eficiente para melhorias principalmente nos indicadores de força, porém não encontramos diferenças significantes para os componentes da composição corporal. Ambos os grupos mostraram respostas semelhantes quanto ao efeito do TC. Dessa forma, concluímos que se faz necessário mais estudos utilizando ou não a TRH, para verificar seus benefícios ou prejuízos para a saúde da mulher.

The menopause is a transitional period characterized by several changes in body composition, including lean mass loss and increase and redistribution of fat. The purpose of this study was to analyze the effects of concurrent training (CT), aerobic and strength on indicators neuromuscular and body composition indicators in postmenopausal women. Participated 18 clinically healthy menopausal women with and without Hormone Replacement Therapy (HRT). They were divided into two groups: with HRT (n = 8, age = 50.12 ± 3.8), and without HRT (n = 10, age = 56.3 ± 7.4). The TC lasts 10 weeks, three days a week and mean duration of 60 min per session. For the strength training were proposed nine exercises for the major muscle groups and for the aerobic training was done walks and running for about 30 minutes. The aerobic training was always done after strength training. Analysis of variance (ANOVA) was used for comparison between groups, to analyze the effects of the training. It was used the post hoc of Scheffé for multiple comparisons. The results showed the efficiency of the CT mainly to improvements in strength indicators, but did not find significant differences in the body composition components. Both groups showed similar responses to the TC. So more studies are needed to a better knowledge about the importance of using HRT, as its benefits or harms to the women health.

Hormonal Changes of the Brain-Dead Organ Donors: A 3-Year Experience / 대한구급학회지

BACKGROUND: Success of transplantation is critically dependent upon the quality of the donor organ and optimal management. Recently, hormonal replacement therapy has been reported to result in rapid recovery of cardiac function and enable significantly more organs to be transplanted, while some other studies show conflicting results. The aim of this study is to comprehensively evaluate changes in basal circulating hormonal levels of the brain-dead organ donors. METHODS: We reviewed the records of all brain-dead patients between January, 2004, and June, 2007. Hemodynamic variables, plasma hormone levels were recorded at following time points: admission to the ICU (T1, baseline), 30 minutes (min) after first apnea test (T2), 30 min after second apnea test (T3), before operation for harvesting (T4). Hormonal measurements included cortisol, adrenocorticotrophic hormone, triiodothyronine (T(3)), thyroxine, free thyroxine, thyroid-stimulating hormone, growth hormone, and testosterone. RESULTS: Nineteen patients were included in this study. Comparisons of hemodynamic parameters and hormonal levels to baseline values revealed no significant changes throughout the study period. When the patients were divided into 2 groups according to the requirement of norepinephrine (either>0.05 or 0.05microgram/kg/min of norepinephrine had T(3) level below the normal range at significantly more time points of measurement (7 vs. 0). CONCLUSION: In this comprehensive assessment of hormonal levels in brain-dead organ donors, we could not observe any significant changes during the ICU stay. Replacement therapy of T(3) may be considered in patients requiring >0.05microgram/kg/min of norepinephrine.

Terapia de reposição hormonal e a mama / Hormonal replacement theraphy and the breast

A terapia de reposição hormonal (TRH) tem sido muito usada para alívio de sintomas climatéricos. Porém, como se sabe, os hormônios esteróides, principalmente os estrogênios, exercem ação promotora na carcinogênese mamária, a segurança da TRH em termos de risco de câncer de mama pode ser questionada. Nesta revisão de literatura, os autores concluíram que a TRH eleva discretamente o risco relativo de câncer de mama, podendo ser considerada quando as vantagens superarem as desvantagens. Mas, para mulheres com antecedente pessoal de câncer de mama ou com fatores predisponentes de alto risco, a TRH deve ser evitada, preferindo-se alternativas não-hormonais.

Hormonal replacement therapy (HRT) has been widely used for the 1llanagement of climateric symptoms. As it is known that steroid hormones, mainly estrogens, are promoting factors for mammary carcinogenesis, the safety of HRT in terms of risk for breast cancer may be cause of concern. In this review literature the authors concluded that HRT increases slightly the relative risk of breast cancer, and may by tailoring considered when the advantages exceed the disadvantages. Neverthless HRT should be avoided in women with personal history of breast cancer or presenting high risk predisposing factors, to whom non-hormonal alternatives are preferred.

The usefulness of laparoscopic myomectomy after Hormone Replacement Therapy in postmenopausal women with uterine myoma / 대한산부인과학회지

OBJECTIVE: This study was undertaken to evaluate the usefulness of laparoscopic myomectomy after hormone replacement therapy in postmenopausal women with uterine myoma. METHODS: The total number of patients with uterine myoma in a postmenopausal women from March 1999 to December 2002 in Department of Obstetrics and Gynecology in Chonnam University Hospital was 137. Patients underwent laparoscopic myomectomy are 12 (Group B) and only hormone replacement therapy without operation are 83 (Group A). The others are not undertaken any treatment (Group C). The number and size of myoma and the development of estrogen-dependent tumor periodically followed up. RESULTS: There were significant differences among three groups with respect to myoma dimension, number. And the risk of developing of estrogen dependent tumor is not increased with Hormone replacement therapy in postmenopausal women. So, laparoscopic myomectomy in a postmenopausal patients would be performed carefully. CONCLUSION: We are not sure whether HRT increases the number and size of the myoma and malignant change when compared with untreated with postmenopausal women. So, laparoscopic myomectomy in a postmenopausal patients would be performed carefully. Further prospective studies with larger groups and a long-term would be helpful in deciding which treatment modality would be appropriate in a postmenopausal patient with myoma.

Minor side effects of hormonal replacement therapy in menopausal Thai women.

Objective : To evaluate type and incidence of minor side effects of hormonal replacement therapy (HRT). Design : Cross-sectional, descriptive study. Patients : 114 women, who were follow up at Menopause Clinic in July 2001. Methods: All women were interviewed about their experience in various symptoms possibly related to HRT side effects. The symptoms before and during HRT were recorded. The symptoms that were present only during HRT but not before HRT were considered as side effects. Results : The study showed that breast pain was the most common side effect of both cyclic HRT (40%) and continuous HRT (38.1%) groups; whereas the complaint of weight gain was more pronounced in the estrogen only (31.8%). Conclusion : Although minor side effects of HRT are not life threatening, they may have influence on the compliance of HRT. The incidence of minor side effects of HRT is varied depending on the HRT regimens. However, the symptoms similar to the HRT side effects are already present prior to HRT in a certain number of patients.

Changes of Bone Mineral Density, Lipid Profiles, and Biochemical Markers after Combination Therapy of Estrogen and Alendronate in Postmenopausal Osteoporosis

OBJECTIVE: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles after combination therapy of continuous hormonal replacement therapy (c-HRT) and alendronate in postmenopausal osteoporosis. METHOD: We studied 89 women with postmenopausal osteoporosis (T-score<2.5) who visited at Department of Rehabilitation Medicine, Kosin Medical Center from August 1999 to March 2001. Subjects were divided into two groups; Group I (n=40), treated with estrogen and alendronate (10 mg/day), and Group II (n=49), treated with estrogen alone. BMD at the lumbar spine and femur, osteocalcin, urine deoxypyridinoline and lipid profiles were measured at baseline and 1-year after treatment. RESULTS: 1) BMD at the lumbar spine increased significantlyin two groups, and BMD in Group I increased significantly more than that in Group II. But, change of BMD on femoral neck was not significantly different. 2) Biochemical bone markers (osteocalcin and urine deoxypyridinoline) decreased significantly in two groups. 3) Total cholesterol and LDL cholesterol decreased significantly in two groups, but HDL cholesterol and triglyceride showed no significant change in two groups. There was no significant differences between two groups in lipid profiles. CONCLUSION: We concluded that combination therapy with c- HRT and alendronate in postmenopausal osteoporosis was more effective than c-HRT, which would not influence on positive effect of estrogen for lipid metabolism.

The Changes of Bone Mineral Density, Biochemical Bone Markers, and Lipid Profiles according to Duration of Menopause and HRT

OBJECTIVE: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles according to the duration of menopause in postmenopausal osteoporosis patient receiving continuous hormonal replacement therapy (c-HRT). METHOD: Sixty seven patients with postmenopausal osteoporosis who have been under c-HRT for more than two years were used as subjects and divided into two groups according to the time past menopause: group I (0~10 years), group II (over 10 years). The changes of BMD, biochemical bone markers, lipid profiles on one year and two years of c-HRT were comparatively analyzed in each group. RESULTS: 1) BMD of lumbar vertebra was increased and biochemical bone markers were decreased after c-HRT in both groups, but BMD of femur from both groups showed no statistical significant changes. 2) The changes in lumbar vertebra, deoxypyridinoline and osteocalcin were significantly higher after first one year than next one year of c-HRT in both groups, with no statistical differences between two groups. 3) Total cholesterol and LDL-cholesterol were decreased, but HDL-cholesterol and triglyceride showed no significant changes after c-HRT in both groups. CONCLUSION: The effects of c-HRT on BMD, biochemical bone markers, lipid profiles were not influenced by postmenopausal period. And the effects of c-HRT during first one year were more prominent than those of c-HRT during next one year.

Long-term compliance with hormonal replacement therapy: Experience of Siriraj menopause clinic.

A retrospective analysis of women who registered for treatment at Siriraj Menopause Clinic in the year 1995 was performed to assess long-term compliance with hormonal replacement therapy (HRT). There were 217 women who registered that year and all were followed up for the following four years. Of these 217 women, 195 commenced HRT and were divided into two groups. The first group of 1,105 women (natural menopause, N) comprised 25 menopause transition and 80 postmenopause cases. The second one of 91 women (surgical menopause, S) was the group who previously underwent total hysterectomy with bilateral salpingooophorectomy. The average age at first consultation in the N group was 52.1 + 6.5 year which was significantly higher than 46.7 + 7.7 year in the S group (P<0.0001). In the N group, compliance was 61.9% at 1 year and 56.1%, 50.4%, 43.8% at 2,3 and 4 years while in the S group compliance was 74.7% at 1 year and 64.8%, 58.2%, 47.2% at 4 years respectively. Compliance with HRT was not statistically different between both groups (P>0.05). Drop out cases were maximum in the first years in both groups and total drop out cases increased slowly and steadily every year for the next four years. Ages at first consultation of compliant and non compliant women in each group were also not statistically different (P>0.05). Long-term compliance with HRT in this study was comparable with previously reported data. Main reasons for non compliance at 4 years were breast symptoms including breast masses and mastalgia, abnormal vaginal bleeding or irregular menses, weight gain and skin problems including acne, melasma and hair loss. These problems are different from other reports. Factors affecting long-term compliance with HRT should be further studied especially in those women who have undergone a surgical menopause.