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[Observational study of criteria involved in the choice of hormone replacement therapy (HRT), when initiated and subsequently adapted].

OBJECTIVES
Multicentre observational longitudinal prospective study in France; search for criteria involved in the choice of the initial dose of oestrogen at the initiation of hormone replacement therapy (HRT); search for explicative and predictive factors for treatment adaptation.


PATIENTS AND METHODS



STATISTICS
description and analysis (factorial analysis of multiple correspondences) of the criteria involved in the choice of the initial dose of oestrogen; percentage of women with treatment adaptation ; analysis (univariate, multivariate) of predictive factors for adaptation.


RESULTS
Six hundred and fifty postmenopausal women, first treated with HRT, with complete data on modification (or not) of their treatment were included. Initial estrogen dose was dose 1 (or low dose) in 66% of patients, dose 2 (or standard dose) in 34 % of patients (N = 643). The preponderant type of HRT use was discontinuous sequential therapy and transdermal formulation. Criteria involved in the choice of the low initial dose (dose 1) were moderate hot flushes, complaint about weight gain, choice of the patient, breast tolerability, uterine bleeding, general safety, hepatic first pass. Criteria involved in the choice of the standard initial dose (dose 2) were important hot flushes, and prevention of postmenopausal osteoporosis. Treatment was adapted in 369 patients e.g. 56.8% of the population (95% CI: 53-60.6 %). The main changes (N = 291) were in 37.5% of the cases (N = 109) a decrease in the dose of estrogen (16.7% of the women (N = 37) initially under dose 2 - or standard dose) or an increase in the dose of oestrogen (17.1% of the women (N = 72) initially under dose 1 - or low dose). In 25% of the cases, there was a change in the dose or type of progestogen, in favor of norpregnane or pregnane derivates.


DISCUSSION AND CONCLUSION
The following factors were associated with a decreased probability of treatment adaptation: more than 5 hot flushes at enrolment, initial dose chosen taking into account tolerance factors, history of hysterectomia, and known diabetes. Conversely, the existence of antihypertensive treatment was associated with an increased probability of treatment adaptation.