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Negative mood changes during hormone replacement therapy: a comparison between two progestogens.

I Björn1, M Bixo, K S Nöjd

  • 1Department of Obstetrics and Gynecology, University Hospital of Umeå, Sweden.

American Journal of Obstetrics and Gynecology
|December 20, 2000
PubMed
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Medroxyprogesterone acetate is preferable to norethindrone acetate for mood symptoms in postmenopausal hormone therapy for women without premenstrual syndrome history. Both progestogens caused cyclic mood and physical symptoms.

Area of Science:

  • Reproductive endocrinology
  • Menopause research
  • Hormone therapy

Background:

  • Postmenopausal hormone replacement therapy (HRT) is used to manage menopausal symptoms.
  • Progestogens are added to estrogen therapy to protect the endometrium.
  • Different progestogens may have varying effects on mood and physical symptoms.

Purpose of the Study:

  • To compare the side effects of medroxyprogesterone acetate (MPA) and norethindrone acetate (NA) in postmenopausal HRT.
  • To evaluate these effects in women with and without a history of premenstrual syndrome (PMS).

Main Methods:

  • A double-blind, randomized crossover study involving 51 postmenopausal women.
  • Participants received continuous estradiol with sequential MPA or NA for 12 days per cycle over five 28-day cycles.

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  • Daily symptom rating scales were used to collect data.

    • Main Results:

    • Cyclic mood and physical symptoms were observed, peaking during the progestogen phase.
    • Symptoms decreased over time but persisted after 5 months.
    • Women with a history of PMS responded strongly to both MPA and NA.
    • MPA resulted in less negative and more positive mood compared to NA in women without a history of PMS.
    • MPA induced more physical symptoms than NA in both groups.

    Conclusions:

    • Medroxyprogesterone acetate (MPA) is a preferred choice over norethindrone acetate (NA) for managing mood symptoms in postmenopausal women without a history of premenstrual syndrome undergoing HRT.
    • Both MPA and NA can induce cyclic mood and physical symptoms during HRT.
    • Individualized treatment decisions should consider a patient's history of PMS.