medrogestone and Endometrial-Hyperplasia

In this study menopausal symptoms, endometrial histology, uterine bleeding pattern, plasma lipid concentrations, bone mineral loss, body weight and blood pressure have been evaluated in postmenopausal women who received continuous conjugated equine estrogens and medrogestone over a 1 year treatment period. By the third month of therapy we detected a significant (p < 0.01) improvement in postmenopausal symptomatology. At the 6th and 12th month, endometrial biopsy specimens revealed atrophic endometrium in all women. Uterine bleeding episodes were observed especially during the first months of treatment. Amenorrhoea was found in all patients only after 8 months of therapy. By the 6th month of therapy, we observed a significant (p < 0.01) decrease of plasma cholesterol and low-density lipoprotein cholesterol levels. Instead, plasma high-density lipoprotein and triglycerides concentrations didn't show significant variation from baseline values. No significant changes in bone mineral density could be detected after 12 months of treatment. Body weight and blood pressure were not significantly altered from baseline. This study suggests that continuous conjugated equine estrogens plus medrogestone treatment appears to be an interesting and safe manner to administer postmenopausal hormone replacement therapy. This regimen could represent a good alternative to sequential estroprogestin therapy in women who do not tolerate withdrawal bleeding.

Topics: Amenorrhea; Atrophy; Biopsy; Dose-Response Relationship, Drug; Endometrial Hyperplasia; Endometrium; Estrogen Replacement Therapy; Estrogens, Conjugated (USP); Female; Humans; Lipoproteins; Medrogestone; Middle Aged; Osteoporosis, Postmenopausal; Triglycerides; Uterine Hemorrhage

Vaginal sonography of the endometrium is a new method of controlling the substitution therapy with oestrogen and progesterone during the postmenopausal period. The advantages of transvaginal ultrasonic diagnosis are that the uterus can be seen from the fornix vaginae, that it is situated at close range, and that the examination can be conducted whether the bladder is filled or not. The differences in thickness and structure of the endometrium, and the limitation to the surrounding myometrium, enable sonographic detection of most of the changes of the endometrium during the postmenopausal period. In our first group of patients, we found an endometrial carcinoma in 2 out of the 60 women with postmenopausal metrorrhagia. The findings were confirmed histologically. Women who have regular bleedings while undergoing hormone therapy during the postmenopausal period, show signs of proliferation in the endometrium under oestrogen therapy and signs of secretion under progesterone therapy.

Topics: Climacteric; Endometrial Hyperplasia; Endometrium; Estrogens, Conjugated (USP); Female; Humans; Medrogestone; Metrorrhagia; Middle Aged; Ultrasonography; Uterine Neoplasms