Progestogen therapy

The WHI trial showed an overall increase in the risk of coronary heart disease in healthy postmenopausal women aged 50 to 79 years taking estrogen-progestogen therapy compared with those taking placebo. The increased risk of coronary heart disease was most apparent at 1 year. The estrogen-alone arm of the WHI showed no effect (either increase or decrease) in the risk of coronary heart disease. Recent analysis showed that women who started hormone therapy closer to the time of menopause tended to have decreased coronary heart disease risk compared to the... 

In the WHI study, estrogen plus progestogen therapy had an increased risk for invasive breast cancer, which did not appear until after 3 years of study participation. The estrogen-only arm of the WHI showed no increase in risk for breast cancer during the 7-year follow-up. 

The WHI study found that postmenopausal women 65 years or older taking estrogen plus progestogen therapy had twice the rate of dementia, including Alzheimer s disease. Combined therapy also did not prevent mild cognitive impairment. 

With regard to hormone use in the adjuvant setting a systematic review in the Cochrane database of six trials involving 4351 women concluded Current evidence does not support the use of adjuvant progestogen therapy in the primary treatment of endometrial cancer (see Martin-Hirsch et al., 1999). 

Significant differences in the pharmacokinetics of prednisolone amongst menopausal women have been described (SEDA-21, 419 412). The postmenopausal women had reduced unbound clearance (30%), reduced total clearance, and an increased half-life. Similar results are seen in the postmenopausal women who took estrogen or estrogen-progestogen therapy. 

Practice Committee of the American Society for Reproductive Medicine. Estrogen and progestogen therapy in postmenopausal women. Fertil Steril 2004 82 Suppl l S70-80. 

In 104 women with established postmenopausal osteoporosis, continuous estrogen + progestogen therapy resulted in increases in bone mineral density of the femoral neck and a fall in systolic blood pressure the most common adverse effects were mastalgia (44%) and vaginal bleeding (29%) (2). 

Jensen J, Christiansen C. Dose-response effects on serum lipids and lipoproteins following combined oestrogen-progestogen therapy in post-menopausal women. Maturitas... 

A small increase in the risk of gallbladder disease has been associated with the nse of HRT. Studies have shown that preparations containing oestrogen alone are associated with a greater risk than combination oestrogen/progestogen therapy. The formulation used is important, with transdermal preparations considered safer. 

Olsson R, Mattsson LA, Obrant K, etal. (1999) Oestrogen-progestogen therapy for low bone mineral density in primary biliary cirrhosis. Liver 19 ... 

Urinary incontinence, which becomes more prevalent with increasing age, usually is not improved by estrogen therapy, and in one large clinical trial, estrogen-progestogen therapy actually increased incontinence. ... 

Transdermal estrogen system Progestogen Therapy 100 mcg/24 h Once or twice weekly Transdermal... 

Continuous-combined estrogen-progestogen therapy—Daily administration of both estrogen and a progestogen. 

Continuous-long cycle estrogen-progestogen therapy—Estrogen... 

Cyclic estrogen-progestogen therapy—Estrogen is taken continuously, with a progestogen added cychcaUy the last 10 to 14 days during each 28-day cycle. 

Hormone therapy—Either eshogen-only therapy or combined es-trogen/progestogen therapy. 

Intermittent-combined estrogen-progestogen therapy— A regimen that combines a daily estrogen with a progestogen administered intermittently in cycles of 3 days on and 3 days off (which is then repeated without interruption). 

Reed SD, Cushing-Haugen KL, Daling JR, Scholes D, Schwartz SM (2004) Postmenopausal estrogen and progestogen therapy and the risk of uterine leiomyomas. Menopause 11 214-222... 

Endometrial cancer In an unusually large investigation into the incidence of endometrial cancer as a complication of various forms of HRT in Finland, using data from the country s Cancer Registry and Medical Reimbursement system, all postmenopausal women who during the years 1994—2006 had been treated with HRT for at least 6 months were identified and compared with the general population [27 ]. Continuous estradiol -b progestogen therapy for 3 years or more was associated with... 

---