Continuous estrogen/progestin therapy in menopause

The incidence of vaginal bleeding, endometrial histology, menopausal symptoms, blood pressure, and serum lipid concentrations were evaluated in 26 women who received either continuous conjugated equine estrogens and medroxyprogesterone acetate (group I, N = 16) or cyclic conjugated equine estrogen + medroxyprogesterone acetate (group II, N = 10) over a 9-month treatment period. At the end of therapy, endometrial biopsy specimens in group I revealed inactive endometrium, whereas one of ten biopsy specimens in group II showed proliferative endometrium. Blood pressure, serum total cholesterol, high-density and low-density lipoprotein cholesterol, and triglyceride levels were not significantly altered from baseline in either group during the 9-month treatment. Vaginal bleeding was virtually eliminated in group I by the end of the study, while 80% of the patients in group II continued to have cyclic menses (p less than 0.001). This pilot study suggests that continuous conjugated equine estrogen plus medroxyprogesterone acetate therapy appears to be a satisfactory method of postmenopausal hormone replacement, effectively reducing menopausal symptoms without any apparent short-term alterations in serum lipids. It has the added benefit of eliminating cyclic menstrual flow.