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Bleeding patterns during continuous estradiol with different sequential progestogens therapy
Costantino Di Carlo1, Annalidia Sammartino, Attilio Di Spiezio Sardo
1Department of Gynecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples Federico II, Naples, Italy.
Menopause (New York, N.Y.)
|September 8, 2005
Summary
Continuous sequential estrogen-progestin therapy (CS-EPT) with transdermal estradiol and various progestogens resulted in regular bleeding for most cycles. Nomegestrol acetate and dydrogesterone showed higher rates of regular bleeding compared to medroxyprogesterone acetate and micronized progesterone.
Area of Science:
- Reproductive Endocrinology
- Hormone Therapy
- Menopause Management
Background:
- Continuous sequential estrogen-progestin therapy (CS-EPT) is a common regimen for hormone replacement.
- Understanding the bleeding patterns associated with different progestogens in CS-EPT is crucial for patient adherence and safety.
- Transdermal estradiol is often used in combination with oral progestogens.
Purpose of the Study:
- To compare the effects of four different progestogens (medroxyprogesterone acetate, nomegestrol acetate, dydrogesterone, micronized progesterone) on monthly bleeding patterns.
- To evaluate bleeding profiles in postmenopausal women undergoing continuous sequential estrogen-progestin therapy (CS-EPT) with transdermal estradiol.
- To determine which progestogen, when combined with transdermal estradiol, yields the most predictable bleeding outcomes.
Main Methods:
- A prospective, open-label, randomized clinical trial involving 100 healthy postmenopausal women.
- Participants were divided into four groups (n=25 each), receiving transdermal estradiol (50 mcg/day) combined with one of four oral progestogens daily from day 14 to 25 of a 28-day cycle.
- Bleeding patterns were meticulously recorded in daily diaries over 12 cycles.
Main Results:
- Out of 937 evaluated cycles, 73.6% exhibited regular progestogen-related bleeding.
- Amenorrhea occurred in 7.8% of cycles, irregular bleeding in 8.3%, and spotting in 10.2%.
- Nomegestrol acetate and dydrogesterone demonstrated significantly higher rates of regular bleeding compared to medroxyprogesterone acetate and micronized progesterone.
Conclusions:
- Continuous sequential estrogen-progestin therapy (CS-EPT) generally induces regular withdrawal bleeding in women without uterine pathology.
- Micronized progesterone was associated with a higher incidence of irregular bleeding episodes compared to other progestogens studied.
- Nomegestrol acetate and dydrogesterone may offer more predictable bleeding profiles in CS-EPT regimens.