Estrogen, conjugated/medroxyprogesterone acetate

Utian WH, Shoupe D, Backmann G, et al. Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and medroxyprogesterone acetate. Fertil Steril 2001 75 1065-1079. 

CEE, conjugated equine estrogens MPA, medroxyprogesterone acetate NETA, norethindrone acetate. 

AECAPS/TexCAPS = Air ForceAexas Coronary Atherosclerosis Prevention Study (Downs et ah, 1998) Helsinki = The Helsinki Heart Study (Frick et al., 1 987) LRC-CPPT = The Lipid Research Clinics Coronary Primary Prevention Trial (insull et al., 1984) Oslo = The Oslo Study (Hjermann et ah, 1988) WOSCOPS = The West of Scotland Coronary Prevention Study (Shepherd et al., 1995) ALLHAT = Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial approximately 13-15% of patients had a history of coronary heart disease (CHD) events are CHD events only WHI = Women s Health initiative RRR = relative risk reduction ARR = absolute risk reduction NNT = number needed to treat NA = not available CEE = conjugated equine estrogen MPA = medroxyprogesterone acetate CARDS = Collaborative Atorvastatin Diabetes Study (presented at the 2004 American Diabetes Association meeting). 

Estrogen alone for days 1M 4, followed by estrogen-progestogen on days 15-28. CEE, conjugated equine estrogens MPA, medroxyprogesterone acetate NETA, norethindrone acetate. 

A 52-year-old postmenopausal patient has evidence of low bone mineral density. She and her physician are considering therapy with raloxifene or a combination of conjugated estrogens and medroxyprogesterone acetate. Which of the following patient characteristics is MOST likely to lead them to select raloxifene ... 

Activella—estradiol, norethindrone acetate CombiFhtch—estradiol, norethindrone Femhrt—ethinyl estradiol, norethindrone acetate Ortho-Pretest—estradiol, norgestimate Premephase—conjugated estrogens, medroxyprogesterone acetate... 

Low-dose hormone therapy (conjugated equine estrogen 0.45 mg and medroxyprogesterone acetate 1.5 mg/day) has demonstrated equivalent symptom relief and bone density preservation without an increase in endometrial hyperplasia. Whether such lower doses will be safer (cause less venous thromboembolism and breast cancer) remains to be seen. 

Estrogens with or without progestins should not be used for the prevention of cardiovascular disease. The Women s Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 19 years of age) during 5 years of treatment with oral conjugated estrogens (0.625 mg) combined with medroxyprogesterone acetate (2.5 mg) relative to placebo.62... 

A study that cannot be faulted on that score is the Women s Health Initiative, a randomized, controlled, primary prevention trial (planned to last for 8.5 years), in which 16 608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited at 40 US clinical centers over the period 1993-98 (9). In one part of this study, 8506 participants received conjugated equine estrogens 0.625 mg/day plus medroxyprogesterone acetate 2.5 mg/day 8102 were given placebo. The primary desired outcome was reduction of coronary heart disease (non-fatal myocardial infarction and death), with invasive... 

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