Amenorrhea frequency with continuous combined hormone replacement therapy: a retrospective analysis. Menopause Study...

Area of Science:

• Gynecology
• Reproductive Health
• Hormone Therapy

Background:

• Menopause is associated with hormonal changes, often necessitating hormone replacement therapy.
• Conjugated equine estrogens (CE) and medroxyprogesterone acetate (MPA) are commonly used to manage menopausal symptoms.
• Understanding amenorrhea and withdrawal bleeding patterns is crucial for optimizing treatment regimens.

Purpose of the Study:

• To evaluate amenorrhea patterns with continuous CE +/- continuous MPA.
• To assess withdrawal bleeding patterns with cyclic MPA therapy.
• To compare the efficacy of different CE and MPA dosing and timing regimens.

Main Methods:

• A 1-year prospective trial involving postmenopausal women receiving CE.
• Group A and B: continuous CE with 2.5 mg and 5 mg MPA, respectively.
• Groups C and D: CE with MPA (5 mg and 10 mg) for the last 14 days of each cycle; Group E received placebo.

Main Results:

• By cycle 7, amenorrhea rates reached 40.4% (Group A) and 52.6% (Group B), increasing over time.
• Among women not amenorrheic by cycle 7, spotting occurred in 42.1% (Group A) and 46.2% (Group B).
• Groups C and D showed predictable withdrawal bleeding, with mean cycle-to-cycle onset variation ≤3 days.

Conclusions:

• Continuous CE + MPA (2.5 or 5 mg) promotes increasing amenorrhea over a 1-year period, potentially improving compliance.
• Cyclic MPA regimens offer predictable withdrawal bleeding, which may be preferred by some postmenopausal women.
• Treatment choice should consider individual patient preferences for amenorrhea versus predictable bleeding patterns.