Bleeding patterns during continuous combined estrogen-progestogen therapy

Article Abstract:

Hormone replacement therapy after menopause is used to alleviate postmenopausal symptoms and prevent osteoporosis, or bone loss. A combined regimen of estrogen and a progestogen is used in women with an intact uterus to prevent cancer and endometrial hyperplasia (the proliferation of the inner lining of the uterus). The progestogen is usually used sequentially with estrogen in a manner that mimics the levels of the female hormones during the menstrual cycle. However, this combined sequential hormone treatment causes menstrual-like vaginal bleeding. Continuous combined estrogen-progestogen treatment was developed to prevent such bleeding, and is based on the assumption that continuous progestogen inhibits estrogen action and prevents the lining of the uterus from building up. Thus, it is expected that continuous combined hormone treatment eliminates the risk of endometrial hyperplasia and prevents bleeding. The effects of two continuous combined regimens on bleeding patterns and menopausal symptoms were assessed in 86 postmenopausal women, aged 45 to 54 years. The women received either continuous combined estradiol-norethisterone acetate or estradiol-cyproterone acetate. Greater incidence and longer duration of bleeding were associated with estradiol-cyproterone acetate treatment. Amenorrhea (the absence of bleeding) occurred in 13 women treated with estradiol-norethisterone acetate and 2 women treated with estradiol-cyproterone acetate. The Kupperman index score, a measure of menopausal symptoms, was reduced from 30 to 40 percent of pretreatment values, indicating considerable relief of postmenopausal symptoms with both treatment regimens. The incidence of hot flushes decreased to 20 percent below pretreatment values. These findings show that continuous combined estrogen-progestogen treatment can prevent menstrual-like vaginal bleeding and alleviate symptoms of menopause, although different types of progestogen vary in their ability to inhibit such bleeding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Drug therapy, Menopause, Uterine bleeding, Uterine hemorrhage

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The cancer question: an overview of recent epidemiologic and retrospective data

Article Abstract:

During menopause the ovaries no longer produce estrogen. Estrogen replacement therapy can be given to protect women from coronary heart disease, osteoporosis, menopausal symptoms affecting the vagina and bladder, hot flashes and mood swings. However, hormone therapy can increase the incidence of certain cancers. Some organs are particularly susceptible to excessive hormone stimulation. Estrogen given alone affects the lining of the uterus (endometrium) by causing uneven shedding. Women given estrogen alone have a ten times greater chance of developing endometrial cancer. Estrogen users with endometrial cancer survive longer than nonestrogen users with endometrial cancer. The longer estrogen replacement therapy is used, the greater the risk for endometrial cancer. The addition of progesterone to existing estrogen replacement therapy regimes decreases the negative effects of estrogen on the endometrium. The increased risk of breast cancer from estrogen therapy is controversial. Women taking higher doses of estrogen had a twofold increase in breast cancer. The protective effect of progesterone with regard to breast cancer has not been studied well. When examining the overall mortality of women, deaths from coronary heart disease were four times greater than deaths from endometrial and breast cancers combined. It is estimated that a daily dose of estrogen given over 10 years would save 302 lives per 100,000 women with their uterus and the lives of 328 women who have had their uterus removed. The benefits of estrogen replacement therapy, with respect to coronary heart disease protection and decreased osteoporosis, far outweigh the risks for cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Development and progression, Demographic aspects, Breast cancer, Hormone therapy, Endometrial cancer, Estrogen, Estrogens, Carcinogenesis, Endometrial hyperplasia

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