OBJECTIVE To study long-term compliance with oral hormonal replacement therapy (HRT). METHODS A total of 151 early postmenopausal women were initially randomly allocated to three groups in a double-blind, placebo controlled trial. Fifty women received continuous combined therapy, another 50 were placed on sequential therapy, while the remaining 51 women were given placebo for 2 years with no subsequent therapy. After 2 years of the trial, the women were followed in an open investigation for a total of 8 years. RESULTS After 8 years, 112 (85%) women were interviewed. None of the women in the combined group had changed to other therapies (46% were still in treatment), 32% were still being treated with sequential therapy and 18% had changed to other HRTs (mainly because the women disliked the monthly bleeding induced). Of the placebo group, 18% had started HRT while 53% still did not receive any therapy. Of the women who had taken combined therapy for 5 years, 95% were still in therapy at the 8-year stage. Of the 25 women who had taken sequential therapy for 5 years, 52% continued until the 8-year stage and a further 16% received other types of HRT. The women who changed HRT switched to continuous combined therapy. CONCLUSIONS The continuous combined treatment might provide an alternative to sequential treatment in postmenopausal women to achieve high long-term compliance.