Compliance considerations with estrogen replacement: withdrawal bleeding and other factors

Am J Obstet Gynecol. 1989 Dec;161(6 Pt 2):1854-8. doi: 10.1016/s0002-9378(89)80006-7.


Withdrawal bleeding and other side effects such as edema, bloating, premenstrual irritability, lower abdominal cramps, dysmenorrhea, and breast tenderness limit compliance with hormonal replacement therapy. Although many of these troublesome side effects can be managed by adjusting the dose or changing the source of the estrogen or progestin components, postmenopausal women view withdrawal bleeding as the most negative factor influencing their decision to use hormonal replacement therapy. Additionally, the potential link between postmenopausal estrogen use and subsequent endometrial hyperplasia and cancer concerns potential users. Cyclic progestins protect the endometrium from hyperplastic changes but may not prevent withdrawal bleeding. Both patient and physician education, including the nature of menopause and the protective role of estrogens in osteoporosis and cardiovascular disease, are critical to improving compliance with hormonal replacement therapy.

Publication types

  • Review

MeSH terms

  • Estrogen Replacement Therapy / adverse effects*
  • Female
  • Humans
  • Patient Compliance*
  • Patient Education as Topic
  • Substance Withdrawal Syndrome
  • Uterine Hemorrhage / chemically induced