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Estradiol and levonorgestrel: effects on bleeding pattern when administered in a sequential combined regimen with a
P H M van de Weijer1, D W Sturdee, T von Holst
1Department of Obstetrics and Gynecology, Gelre Hospital, 7300 DS Apeldoom, The Netherlands.
Summary
Transdermal estradiol/levonorgestrel patches offer effective cycle control for postmenopausal women. This sequential combined regimen demonstrated good bleeding predictability and high acceptability, with dose-dependent effects on bleeding patterns.
Area of Science:
- Endocrinology
- Gynecology
- Pharmacology
Background:
- Menopause is associated with hormonal changes, often necessitating hormone replacement therapy (HRT).
- Sequential combined HRT aims to mimic natural hormonal cycles, managing menopausal symptoms while controlling bleeding patterns.
- Transdermal delivery offers an alternative route for HRT administration.
Purpose of the Study:
- To evaluate the bleeding patterns and acceptability of sequential combined transdermal estradiol/levonorgestrel in postmenopausal women.
- To assess the dose-dependency of bleeding control with varying patch sizes and dosages.
- To determine the overall acceptance of the treatment regimen by participants.
Main Methods:
- A 1-year, randomized, multicenter study involving 468 postmenopausal women.
- Participants received 7-day sequential transdermal patches with 17 beta-estradiol alone for 2 weeks, followed by 17 beta-estradiol/levonorgestrel for 2 weeks.
- Three different patch sizes (15, 22.5, 30 cm2) delivering escalating doses were used.
Main Results:
- Cyclic bleeding occurrence was dose-dependent, increasing from 40% to 76% with higher doses.
- Intermittent bleeding incidence rose with dosage, while amenorrhea decreased significantly across dose groups.
- Bleeding regularity and predictability were high; 90% of women found the recurrence of bleeding acceptable.
Conclusions:
- Sequential combined transdermal estradiol/levonorgestrel provides excellent cycle control in postmenopausal women.
- The treatment regimen is well-accepted, with high patient satisfaction regarding bleeding patterns.
- Transdermal delivery of sequential combined HRT is a viable option for managing menopausal symptoms and bleeding.