Comparison of two menopausal hormone therapy regimens in managing menopausal symptoms: a retrospective study

Femoston (estradiol/dydrogesterone) and Climen (estradiol valerate/cyproterone acetate) are two widely prescribed sequential menopausal hormone therapy (MHT) regimens that differ in estrogen formulation, progestogen component, and sequential pattern. Head-to-head comparative data on their clinical efficacy and safety remain scarce.

This single-center retrospective study enrolled 80 perimenopausal and early postmenopausal women who received Femoston (n = 42) or Climen (n = 38) for six consecutive treatment cycles between January 2022 and January 2025. The primary outcome was post-treatment Kupperman Menopausal Index (KMI) score assessed by multivariable linear regression. Secondary outcomes included individual symptom response rates, serum sex hormone levels, lipid profile, hepatic enzymes, fasting plasma glucose, endometrial thickness, and adverse events.

Both regimens produced substantial reductions in KMI scores from baseline (Femoston: 26.90 ± 5.72 to 10.48 ± 3.72; Climen: 27.53 ± 6.08 to 11.74 ± 4.12; both P < 0.001). After multivariable adjustment, treatment group was not independently associated with post-treatment KMI score (β = 0.58, 95% CI: -0.82 to 1.98, P = 0.412). Response rates for hot flashes/sweating, insomnia, and mood symptoms were comparably high between groups (all P > 0.05). Both regimens significantly suppressed FSH and LH and elevated E₂. Regarding lipid profiles, Femoston significantly increased HDL-C (P = 0.001) whereas Climen did not (P = 0.402); Climen significantly increased TG (P = 0.048) whereas Femoston did not (P = 0.583). After Benjamini-Hochberg correction, the between-group difference in HDL-C remained significant (adjusted P = 0.024). No clinically significant changes in hepatic enzymes, fasting glucose, or endometrial thickness were observed in either group, and no serious adverse events occurred.

Femoston and Climen provide comparable short-term menopausal symptom relief. The more favorable lipid profile with Femoston, particularly its HDL-C benefit, may inform individualized regimen selection, especially in women without indications for antiandrogenic therapy. Prospective studies with longer follow-up are warranted to evaluate hard cardiovascular endpoints.