结合雌激素对绝经后妇女血液流变学影响的探讨

目的 探讨不同剂量结合雌激素对绝经后妇女血液流变学及临床症状的影响。方法 将66例绝经后妇女分为三组,其中A组每日服用CEE 0.625 mg+ 安宫黄体酮(MPA)2 mg+ 钙尔奇 D 600 mg,B纽每日服用CEE 0.3 mg+MPA 2mg+钙尔奇D 600 mg,C组为对照组,每日单用钙尔奇D 600 mg,观察治疗前后血液流变学及Kupgermn评分的变化。结果 A组血浆粘度、纤维蛋白原明显低于对照组,B组全血高切粘度、低切粘度和血浆粘度明显低于对照组。两组用雌激素后,与自身对照,全血高切粘度和红细胞变形能力均明显改善,两组更年期症状均明显改善,A组阴道出血率54.5％,明显高于B组。结论 结合雌激素加孕激素可以改善绝经后妇女血液流变学指标,每日结合雌激素0.3 mg加安宫黄体酮2 mg与CEE 0.625 mg加MPA 2 mg效果相似。     

绝经妇女雌激素补充疗法治疗骨质疏松症的研究

目的 :探讨绝经后妇女骨质疏松的治疗方法。方法 :将 86例绝经后骨质疏松患者随机分成 A组 (实验组 ,口服利维爱加钙尔奇 - D片 )、B组 (对照组 ,单服钙尔奇 - D片 ) ,比较两组的更年期症状与骨密度 (BMD)、血清降钙素 (h-CT)、血清骨钙素 (BGP)和甲状旁腺素 (PTH)等指标的变化情况。结果 :A组的临床有效率为 79.0 7% ,明显高于对照组(5 8.14 % ,P<0 .0 5 )。A组 BMD明显增加 (P<0 .0 5 ) ,BGP、h- CT水平显著增高 (P<0 .0 1) ,PTH水平显著降低 (P<0 .0 5 )结论 :口服利维爱加钙尔奇 - D片 ,是治疗绝经后妇女骨质疏松较好的方法     

两种激素补充治疗方案联合钙剂对绝经后妇女骨密度的影响

目的　研究利维爱 1 2 5mg d和结合雌激素 (CEE) 0 6 2 5mg +安宫黄体酮 (MPA) 2mg联合钙剂对绝经后骨质疏松和低骨量妇女骨密度的影响。方法　绝经后妇女 30人 ,分为利维爱组和CEE组。利维爱组8例为骨质疏松 ,中位年龄 6 4岁 ,中位绝经年限 1 4年 ;9例为低骨量 ,中位年龄 5 2岁 ,中位绝经年限 3年 ,均给予利维爱 1 2 5mg d、Ca -D 6 0 0mg d口服。CEE组中位年龄为 5 1岁 ,中位绝经年限为 2 5年。治疗前及治疗 1年时用DEXA方法检查前臂远端骨密度各 1次 ,做为自身对照 ,对比骨密度变化情况同时每年通过阴道B超监测子宫内膜的厚度。结果　利维爱组骨质疏松患者 ,松质骨骨密度增长中位数为 +4 0 % ,密质骨为 +2 6 % ;低骨量者 ,用利维爱者分别为 0和 - 1 0 % ,用CEE者为 +0 3%和 - 0 7%。所有患者依从性好 ,无明显副作用发生。结论　利维爱 1 2 5mg d联合钙剂能够提高绝经后骨质疏松妇女的前臂骨密度     

绝经前全子宫切除保留卵巢对妇女骨代谢及骨密度的影响

目的 :追踪观察绝经前妇女全子宫切除保留卵巢对远期骨代谢及骨密度的影响。方法 :对比观察绝经前行全子宫切除保留单侧卵巢 4 8例、全子宫切除保留双侧卵巢 15例和正常妇女 30例的血清钙 (Ca)、血清磷 (P)、血清碱性磷酸酶 (AKP)、血清骨钙素(BGP)、空腹尿Ca Cr及尿HYP Cr值、骨密度值的变化和差异。结果 :全子宫切除保留单侧卵巢组血AKP值、BGP值、空腹尿Ca Cr和尿HYP Cr均显著高于对照组 (P <0 0 5 ) ,而骨密度值则显著低于对照组 (P <0 0 5 )。保留双侧卵巢组尿HYP Cr显著高于对照组 (P <0 0 5 )。结论 :子宫全切除保留单侧卵巢者远期骨转换加快 ,导致骨丢失及骨密度下降 ,双侧卵巢保留者骨吸收亦加快 ,但骨密度无下降     

补钙和雌、孕激素替代治疗对骨的保护作用——一年的前瞻性比较

选择86例绝经10年以内妇女,先补钙6个月(500mg/日),达到不缺钙的目的。然后随机分为三组:笫一组继续给钙,第二组除继续补钙外,给以小剂量激素持续治疗(结合雌激素0.3mg/日,安宫黄体酮2.5mg/H);第三组除补钙外,给以中剂量激素周期性治疗(结合雌激素0.625mg/日,从1～25天、安宫黄体酮5mg/日从16～25天);以比较不同治疗对改善绝经后症状和保护骨质的作用。以后测量腰椎骨密度和骨质含量,桡骨骨矿含量以及全身骨质的更新率。     

阿仑膦酸钠治疗绝经后妇女骨质疏松症的临床研究

目的:评价阿仑膦酸纳治疗绝经后妇女骨质疏松症的疗效及安全性.方法:选择120个病例,试验组和对照组按1∶1比例分配,每组各60例:试验组为阿仑磷酸钠加钙尔奇D600;对照组为安慰剂加钙尔奇D600.所有入组的患者进入12个月的双盲期治疗.结果:12个月时试验组和对照组的腰椎总骨密度变化率分别为-9.64%和-13.15%,两组比较差异有统计学意义(P<0.05).用药12个月后,试验组血骨钙素下降5.07 ng/ml,对照组下降2.41ng/ml,两组比较差异有统计学意义(P<0.05);用药12个月后,试验组血C端交联多肽下降0.12ng/ml,对照组下降0.01 ng/ml.两组比较差异有统计学意义(P<0.05).治疗期间,两组胸椎和腰椎侧位X线检查均无新的椎体骨折发生,未发生其他部位确切骨折,未发生严重不良事件.结论:阿仑膦酸钠能明显抑制骨吸收作用,减少腰椎骨量的丢失,且不良反应较少,是绝经后妇女一种理想的预防和治疗骨质疏松症的药物.     

结合雌激素联合方案连续应用防治绝经早期妇女骨量丢失的观察

目的　探讨两种剂量结合雌激素 (CEE)对绝经早期妇女骨丢失的影响及副作用。方法将 2 36例绝经妇女分为 3组 ,A组每日口服CEE 0 62 5mg+醋甲羟孕酮 (MPA) 2mg +钙剂 (Ca D) 1片(含元素钙 60 0mg) ;B组每日口服CEE 0 3mg +MPA 2mg +Ca D 1片 ;C组每日仅服Ca D 1片 ,连续用药 2年。于治疗前、治疗 1 2及 2 4个月测量第 2～ 4腰椎 (L2～ 4 )的骨密度 (BMD) ,记录每月阴道出血情况。结果　A组治疗前、治疗 1 2及 2 4个月 ,L2～ 4 BMD分别为 (1 0 62± 1 4 1 )、(1 0 86± 1 4 5)及 (1 1 0 1±1 34)mg/cm2 ,治疗前后比较 ,差异均有极显著性 (P <0 0 0 1 ) ;B组分别为 (1 0 81± 1 35)、(1 1 1 1± 1 68)及(1 0 90± 1 50 )mg/cm2 ,治疗 1 2个月时与治疗前比较 ,差异有显著性 (P <0 0 5) ,治疗 2 4个月时与治疗前比较 ,差异无显著性 (P >0 0 5) ;C组分别为 (1 0 70± 1 1 9)、(1 0 65± 1 34)及 (1 0 53± 1 30 )mg/cm2 ,治疗前后比较 ,差异均无显著性 (P >0 0 5)。治疗前后BMD的变化 ,A与C组、B与C组之间差异均有显著性 (P <0 0 0 1 ,<0 0 5) ;A与B组治疗 1 2个月时的BMD比较 ,差异无显著性 (P >0 0 5) ,2 4个月时比较 ,差异有极显著性 (P <0 0 1 )。各组子宫内膜均无不典型增生。A、B组出血率 ,治     

绝经后妇女血清胰岛素样生长因子结合蛋白与骨矿密度的关系

为评价绝经后妇女血清胰岛素样生长因子结合蛋白(IGFBP)与骨密度(BMD)测量和骨转换的生化指标的关系,选择未服致骨质疏松药,在研究前6个月未服钙VitD、降钙素或雌激素的37例正常健康和14例有骨质疏松的绝经后妇女为研究对象。应用Western配体电泳法和放免测定法测血IGFBPs和骨骼。应用双能X光吸收测量仪测定BMD,并测定尿钙和肌酐比值。 有或无骨质疏松绝经后妇女的年龄、身高、体重和绝经后时间均无显著差异。血清骨钙素(为6.06     

不同方案联合用药治疗围绝经期及绝经后期骨质疏松症的疗效观察

目的 探讨不同方案联合用药治疗围绝经期及绝经后期骨质疏松症(OP)的疗效.方法 选择2008年7月至2009年12月在温州医学院附属第二医院妇科门诊就诊的伴有骨量减少或OP的围绝经期及绝经后期妇女109例,随机分为3组,A组36例,口服氨基酸螯合钙1000 mg/d+阿法骨化醇0.25μg/bid;B组40例,口服氨基酸螯合钙1000 mg/d+阿法骨化醇0.25 μg/bid+替勃龙1.25 mg/d;C组33例,口服氨基酸螯合钙1000 mg/d+阿法骨化醇0.25μg/bid+阿仑膦酸钠70 mg(每周1次).3组妇女均连续服药48周.治疗前、后采用双能X线吸收法测定腰锥第1～4节(L1-4)及左股骨骨密度(BMD);同时采用酶联免疫吸附试验检测血清骨碱性磷酸酶(BALP)、羟基末端肽(CTX)、25-羟维生素D3[25(OH)D3]水平.结果 109例中共有7例(6.4%,7/109)因自动停药、副反应较重不能忍受或失去联系而退出,其中A组2例(失去联系)、B组3例(自动停药)、C组2例(上腹部隐痛不适,烧灼感),退出病例未纳入统计.(1)疼痛症状改善:3组妇女治疗48周后,临床疼痛等症状均明显改善,改善率分别为85%(29/34)、92%(34/37)和94%(29/31);(2)BMD:3组妇女治疗后BMD均明显提高,治疗前A、B、C组L1-4BMD分别为(0.88±0.15)、(0.89±0.18)、(0.87±0.10)g/cm2;治疗后分别为(0.90±0.01)、(0.93±0.09)、(0.91±0.11)g/cm2;治疗前A、B、C组左股骨BMD分别为(0.87±0.07)、(0.87±0.07)、(0.85±0.12)g/cm2;治疗后分别为(0.90±0.03)、(0.91±0.08)、(0.89±0.12)g/cm2.B、C组与A组比较,差异均有统计学意义(P<0.01),而B、C两组间比较,差异无统计学意义(P>0.05);(3)骨代谢指标:治疗前A、B、C组BALP分别为(26±6)、(26±9)、(28±7)μg/L,治疗后分别为(22±5)、(20±9)、(22±8)μg/L,3组治疗后均较治疗前显著下降,差异有统计学意义(P<0.05);治疗前A、B、C组CTX分别为(0.85±0.20)、(0.84±0.47)和(0.88±0.11)ng/L,治疗后分别为(0.81 ±0.19)、(0.77±0.33)和(0.82±0.14)ng/L,3组治疗后均较治疗前显著下降,差异有统计学意义(P<0.05).结论 3种联合用药方案均可用于OP的治疗,可降低骨转换、增加BMD、减少骨吸收;A组方案可作为基础治疗,B、C组方案较基础治疗效果好.     

白细胞介素—6受体在绝经后骨质疏松症发病机制中的作用

目的：探讨白细胞介素－6受体（IL－6R），雌激素（E2）在绝经后骨质疏松症发病机制中的作用。方法：131例健康妇女，年龄31－72岁，其中64例未绝经者按年龄分组，67例绝经者，按绝经年限分组，分别空腹抽取静脉血10mL，取血清检测E2，卵泡刺激素（FSH），可溶性白细胞介素－6受体（sIL-6R)，可溶性糖蛋白（sgp130)，骨钙素（BGP），碱性磷酸酶（AKP），钙（Ca),磷（P）等指标，同时测定腰椎及股骨颈骨密度（BMD），结果：研究对象的E2水平及BMD随年龄及绝经年限增加逐年下降，BMD和E2呈正相关，sIL-6R和sgp130在绝经前各组变化差异不明显，但均有随年龄和绝经年限增加而上升的趋势，和E2，BMD呈明显负相关，BGP和AKP绝经后各组明显高于绝经前各组，血钙，血磷水平各组变化不大。结论：妇女随着年龄增加，BMD逐年下降，特别是进入绝经期后，BMD下降速度加快，E2水平下降可促进IL－6R的分泌，并进一步促进由白细胞介素－6（IL－6）介导的骨吸收的增加，绝经后骨质疏松的主要原因是由于转换增加，骨形成和骨吸收之间不平衡。     

A randomized,double-blind,placebo-controlled,multicenter study that assessed the endometrial effects of norethindrone acetate plus ethinyl estradiol versus ethinyl estradiol alone

OBJECTIVE: The purpose of this study was to determine the incidence of endometrial hyperplasia in subjects who receive continuous norethindrone acetate and ethinyl estradiol combinations versus unopposed ethinyl estradiol. STUDY DESIGN: Nine hundred forty-five postmenopausal women were randomly selected for 12 months of treatment with one of six blinded norethindrone acetate/ethinyl estradiol combinations (milligrams of norethindrone acetate/micrograms of ethinyl estradiol: 0/5, 0.25/5, 1/5, 0/10, 0.5/10, or 1/10) or to open-label 0.625 mg conjugated equine estrogens/2.5 mg medroxyprogesterone acetate. Endometrial hyperplasia and endometrial proliferation were assessed by biopsy at screening, months 6 and 12. RESULTS: Endometrial hyperplasia developed in 26 subjects: Placebo, 0/5 and 0.25/5 (1 subject each) and 0/10 (23 subjects). Significantly less endometrial proliferation was measured in the 1/5 norethindrone acetate/ethinyl estradiol and other norethindrone acetate/ethinyl estradiol combination groups and in the 0.625 mg conjugated equine estrogens/2.5 mg medroxyprogesterone acetate group, than in unopposed ethinyl estradiol groups (6 months: P <.004; 12 months: P <.001). Treatment with 1/5 norethindrone acetate/ethinyl estradiol and with other norethindrone acetate/ethinyl estradiol combinations significantly reduced endometrial proliferation compared with 0.625 mg conjugated equine estrogens/2.5 mg medroxyprogesterone acetate (6 and 12 months: P <.02). CONCLUSION: Norethindrone acetate protects the endometrium from estrogen-induced hyperplasia and changes in proliferative status. In addition, norethindrone acetate/ethinyl estradiol-treated subjects had significantly less endometrial proliferation compared with 0.625 mg conjugated equine estrogens/2.5 mg medroxyprogesterone acetate-treated subjects.     

A study of combined continuous ethinyl estradiol and norethindrone acetate for postmenopausal hormone replacement

In a blinded, prospective, dose-response pilot study of continuous estrogen-progestin replacement therapy, 77 thin, nonsmoking, white women, who were 12 to 60 months postmenopausal and had normal medical histories, were randomly assigned to receive one of five dose combinations of daily ethinyl estradiol and norethindrone acetate (20 micrograms and 1.0 mg, 10 micrograms and 1.0 mg, 10 micrograms and 0.5 mg, 5 micrograms and 1.0 mg, and 5 micrograms and 0.5 mg) or conjugated estrogens 0.625 mg on days 1 to 25 and medroxyprogesterone acetate 10 mg on days 16 to 25. An additional 10 women meeting the same criteria served as a comparison group by taking calcium only. During 12 months of therapy, continuous users had significantly less vaginal bleeding and spotting than did sequential users. As compared with baseline values, bone metabolism and computerized tomographic measurements of vertebral trabecular bone density at month 12 indicated reduced bone turnover and increased density in hormone users. Endometrial biopsy specimens were negative for hyperplasia and neoplasia. The continuous ethinyl estradiol-norethindrone acetate tablet, even at the lowest doses studied, provided the same salutary effects on bone, endometrium, and postmenopausal symptoms as sequential therapy while minimizing annoying vaginal bleeding and spotting.     

Effect of daily hormone therapy and alendronate use on bone mineral density in postmenopausal women

OBJECTIVE: To evaluate the effect of daily oral and transdermal hormone therapy alone or in combination with alendronate on bone mineral density in postmenopausal women. DESIGN: Comparative prospective clinical study. SETTING: Outpatient clinic of a training and research hospital. PATIENT(S): One hundred seventy-three consecutive postmenopausal women with no previous hormone therapy and a bone mineral density T score <-1 SD were randomly enrolled. INTERVENTION(S): Oral conjugated estrogen, alone or with alendronate, or transdermal estrogen, alone or with alendronate, given for 1 year. All patients also received medroxyprogesterone acetate and calcium. MAIN OUTCOME MEASURE(S): Bone density measurement at L2 to 4 region by dual-energy X-ray absorptiometry. RESULTS: At the end of 1 year, significant increase in bone density measurements were seen in all groups. Oral conjugated estrogen and transdermal estrogen have the same effect on bone mineral density loss. Hormone therapy alone stabilized the bone mineral density loss. Hormone therapy together with alendronate resulted in better values in all groups. CONCLUSION: Hormone therapy is adequate in osteopenic women. However, hormone therapy plus alendronate is advantageous in women with considerable bone mineral density loss.     

Effects of low-dose continuous combined conjugated estrogens and medroxyprogesterone acetate on menopausal symptoms, body weight, bone density, and metabolism in postmenopausal women.

OBJECTIVE: The purpose of this study was to determine the effects of a low dose of conjugated equine estrogens and medroxyprogesterone acetate plus calcium supplementation on bone density, metabolism, body weight, and symptoms in young postmenopausal women. STUDY DESIGN: Sixty postmenopausal women, aged 45 to 56 years, were randomized in an open-label, 2-year trial that compared treatment with low-dose continuous combined hormone replacement therapy that contained 0.3 mg of conjugated equine estrogens and 2.5 mg of medroxyprogesterone acetate plus 1000 mg of calcium per day or treatment with 1000 mg of calcium per day alone. Menopausal symptoms were evaluated for the first 12 weeks of the study; bleeding profiles, bone mineral density, bone turnover, and body weight were assessed for 24 months. RESULTS: After 24 months, we evaluated 15 subjects in the control group (with a 50% drop-out rate) and 23 patients (with a 23% drop-out rate) in the low-dose continuous combined hormone replacement therapy group. Low-dose continuous combined hormone replacement therapy was effective in reducing menopausal clinical symptoms and provided a favorable bleeding profile and minimal side effects. In comparison with basal values, bone mineral density significantly (P <.05) increased by 2.72% +/- 0.3% in the low-dose continuous combined hormone replacement therapy group and decreased by 7.9% +/- 0.8% (P <.05) in the control group after 24 months, with parallel changes in bone metabolism marker action. In the control group, body mass index significantly (P <.05) increased from baseline value with a weight gain of 3%; in the low-dose continuous combined hormone replacement therapy group, the body mass index did not change after 24 months of treatment, and the 1.3% gain in body weight was not significant. CONCLUSION: Low-dose continuous combined hormone replacement therapy can alleviate subjective symptoms and minimize body transformations that are associated with early menopause and provide an effective protection against the activation of bone turnover and osteoporosis.     

Preventing postmenopausal bone loss with ossein-hydroxyapatite compounds. Results of a two-year, prospective trial.

OBJECTIVE: To evaluate, in postmenopausal women who refuse hormone replacement therapy (HRT), whether continuous administration of an osseinhydroxyapatite compound (OHC) reduces bone loss and protects from osteoporosis. STUDY DESIGN: Sixty postmenopausal women were included in an open study and were allocated to three groups. The first group (n = 19) received treatment consisting in 3.32 g/d of OHC per day, the second group (n = 21) received 2.5 g of calcium carbonate per day, and the third group (n = 20) was a treatment-free control group. Bone mineral density (BMD), assessed by dual x-ray absorptiometry, was measured prior to and at 12 and 24 months of treatment. RESULTS: Subjects on OHC therapy did not show significant changes related to baseline on bone mass across the study, whereas a significant decrease was detected in the calcium carbonate group during the second year (-3.7%, P < .05) and in the control group at the first and second BMD measurement (-3.5%, P < .05; -5.6%, P < .01). CONCLUSION: Continuous administration of OHC prevents bone loss in postmenopausal women, suggesting that this drug may be useful in the management of postmenopausal bone loss.     

Contrasting effects of two hormone replacement therapies on the cardiovascular and mammary gland outcomes in surgically postmenopausal monkeys

OBJECTIVE: The purpose of this study was to compare the effects of two hormone replacement therapies on the intermediate end points of coronary heart disease and mammary gland hyperplasia in postmenopausal monkeys.Study Design: Surgically postmenopausal cynomolgus monkeys were fed an atherogenic diet for 12 months while receiving no treatment (control, n = 19), conjugated equine estrogens plus continuous medroxyprogesterone acetate (n = 19), or ethinyl estradiol plus norethindrone acetate (n = 21) at doses that were scaled from those doses taken by women. RESULTS: Quantitative coronary angiography revealed that the arteries of the control group and the conjugated equine estrogens plus continuous medroxyprogesterone acetate-treated animals constricted in response to acetylcholine (-5.4% +/- 1.4% and -6.2% +/- 1.5%, respectively), whereas those arteries in the animals in the ethinyl estradiol plus norethindrone acetate group did not (P =.002). The incidence of dobutamine-induced ST-segment depression in the ethinyl estradiol plus norethindrone acetate group (10.5%) was significantly less than in the control group (68.8%, P =.001) or the conjugated equine estrogens plus continuous medroxyprogesterone acetate group (50%, P =.01). Conjugated equine estrogens plus continuous medroxyprogesterone acetate, but not ethinyl estradiol plus norethindrone acetate, induced diffuse epithelial tissue proliferation in the mammary glands (P =.0006). CONCLUSION: Ethinyl estradiol plus norethindrone acetate protected against atherosclerosis-induced endothelium-mediated vasoconstriction of coronary arteries and heart rate-induced myocardial ischemia and did not induce epithelial tissue proliferation (tissue density) in the mammary gland.     

Menopausal bone loss in long-term users of depot medroxyprogesterone acetate contraception

OBJECTIVE: The purpose of this study was to determine the rate of early postmenopausal bone loss in women who had used depot medroxyprogesterone acetate contraception through to menopause. STUDY DESIGN: Bone mineral density at the lumbar spine and femoral neck was assessed prospectively over 3 years in 15 women who reached a natural menopause and who did not undergo hormone replacement therapy and in 16 long-term users of depot medroxyprogesterone acetate who discontinued depot medroxyprogesterone acetate only on reaching menopause. Of the latter, 5 women subsequently underwent hormone replacement therapy. RESULTS: Early menopausal bone loss was rapid in the control group (6% from both sites over 3 years), but the users of depot medroxyprogesterone acetate (who did not take hormone replacement therapy) showed little change in bone mineral density. Between-group differences were statistically significant at years 2 and 3 at both sites (P <.03-<.002). In the users of depot medroxyprogesterone acetate who underwent hormone replacement therapy, bone mineral density increased significantly (P <.03) at the lumbar spine and was stable at the femoral neck. CONCLUSION: Women who use depot medroxyprogesterone acetate through to menopause have attenuated rates of bone loss from the lumbar spine and femoral neck, presumably because they have already lost the estrogen-sensitive component of bone.     

Efficacy of a continuous estrogen-progestin regimen in the menopausal patient

The major concern with the use of unopposed estrogen is its neoplastic effect on the endometrium. Progestins used to oppose the estrogen may be associated with vaginal bleeding and reversal of estrogen's protective changes in serum lipoprotein concentrations. A study was performed in which all postmenopausal women received conjugated equine estrogen for days 1-28; with group I receiving 2.5 mg medroxyprogesterone acetate for days 1-28, group II receiving 5 mg medroxyprogesterone acetate for days 1-28, and group III receiving 5 mg medroxyprogesterone acetate for days 17-28. Pre- and postdrug evaluations of the endometrium revealed atrophic changes after therapy with continuous combined estrogen-progestin. Pre- and poststudy evaluation of serum lipoprotein concentrations demonstrated significant declines in cholesterol and low-density lipoprotein cholesterol within groups I and III, and no change in group II. All patients kept a weekly diary recording any vaginal bleeding or change in vasomotor symptoms. The results suggest that a continuous regimen of 0.625 mg conjugated equine estrogen with 2.5 mg medroxyprogesterone acetate is beneficial as a primary hormonal replacement therapy for the postmenopausal patient.     

Effects of trimonthly progestin administration on the endometrium in elderly postmenopausal women who receive hormone replacement therapy: a pilot study

OBJECTIVE: The purpose of this study was to determine the effect of trimonthly progestin administration on the endometrium in elderly postmenopausal women who receive hormone replacement therapy. STUDY DESIGN: This was a prospective, randomized, double-blind, placebo-controlled study at a university teaching program. Twenty-five postmenopausal women who were >or=75 years old with an intact uterus were assigned randomly to receive conjugated equine estrogens (0.625 mg/d plus medroxyprogesterone acetate 5 mg/d for 13 days every 3 months (n = 13) or placebo (n = 12) for 9 months). At the end of the 9 months, patients in the hormone replacement therapy arm continued therapy for an additional 9 months. Statistical analysis was performed with the Student t test, the chi(2) test, and the Fisher exact test. RESULTS: Transvaginal sonography was performed at baseline and at 9 and 18 months. Endometrial biopsy was performed if the endometrial thickness was >4 mm or as clinically indicated at 18 months. Patients in the hormone replacement therapy group demonstrated a significant increase in endometrial thickness between baseline (3.9 + 0.8 mm) and 9 months (8.0 + 4.8 mm). There were no cases of endometrial hyperplasia at the 18-month endometrial biopsy. CONCLUSION: Trimonthly progestin administration in elderly postmenopausal women who receive hormone replacement therapy may be a reasonable alternative to the monthly administration of progestin in hormone replacement therapy.     

Uterine effects of raloxifene in comparison with continuous-combined hormone replacement therapy in postmenopausal women

OBJECTIVE: We sought to compare the uterine effects of raloxifene with those of continuous-combined hormone replacement therapy. STUDY DESIGN: This randomized, double-blind 24-month study involved 136 postmenopausal women who received raloxifene 150 mg/d or conjugated equine estrogens 0.625 mg/d with medroxyprogesterone acetate 2.5 mg/d. After baseline evaluations, endometrial biopsy specimens were obtained, and endometrial thickness was measured annually by means of transvaginal ultrasonography. Statistical analyses were performed with an intention-to-treat approach. RESULTS: In the raloxifene group at the end point of the study 94.4% of biopsy specimens showed normal benign postmenopausal endometrium and 5.6% were classified as benign stimulatory endometrium. In the continuous-combined hormone replacement therapy group at the end point of the study 78.7% of biopsy specimens showed normal benign postmenopausal endometrium, 19. 1% were classified as benign stimulatory endometrium, and 2.1% showed benign abnormal postmenopausal endometrium. Mean endometrial thickness was unchanged from baseline with raloxifene and was increased significantly by 0.5 mm at 12 months with continuous-combined hormone replacement therapy. CONCLUSION: Raloxifene 150 mg/d did not increase endometrial thickness or cause endometrial proliferation in healthy postmenopausal women.