Combined estrogen and progestogen for the menopause

A single-blind pilot study using combined estrogen and progestogen therapy was undertaken in 25 patients for a period of six months in an attempt to evaluate symptomatic control, the acceptability or otherwise of bleeding patterns, and the effect on endometrial pathology. Two different progestogens were employed, i.e. norgestrel and norethisterone acetate, and each was given in combination with estradiol valerate in a cyclical and a continuous regime. Symptomatic control was good in all groups, but there was a mild recrudescence of some symptoms during the tablet-free interval in the cyclical groups. Regular withdrawal bleeding was reported in almost all cases receiving cyclical therapy, and unscheduled bleeding was noted in those on continuous regimes. Endometrial hyperplasia did not occur following treatment in any of the groups, and there was a return to the normal histology in two patients in whom hyperplasia existed prior to treatment. These results support the view that endometrial hyperplasia is least likely to occur if progestogens are administered in combination with estrogen. There were no obvious differences between the effects of the two progestogens.