Efficacy and safety of estriol replacement therapy for climacteric women

As an estrogen derivative, estriol is rather effective in the relief of climacteric symptoms due to estrogen deficiency. When given one dose a day, it will not provoke endometrial proliferation and shedding. Thus, it is suitable for postmenopausal women who no longer want to have uterine bleeding and for those with comparatively higher risk of endometrial hyperplasia. In the aspect of postmenopausal osteoporosis, the prevention of further bone loss due to estrogen deficiency is also important and to be evaluated.

We collected 20 patients, aged 44-62 years, who had undergone either natural or surgical menopause and were treated with estriol succinate (Synapause; Organon; Holland 2 mg/tab) 2 mg/day for 2 years, with relief of climacteric symptoms evaluated after the first 3 months of treatment. Bone mineral density (BMD) of lumbar spine was measured using quantitative computed tomography (QCT) after one and two years of treatment, respectively.

Estriol was very effective in the improvement of major subjective climacteric complaints in 86% of patients, especially hot flush and insomnia within 3 months. The atrophic genital changes caused by estrogen deficiency were also improved satisfactorily. No subjective symptoms induced by the therapy were seen. The rate of uterine bleeding was low, complained by only one patient. However, our study did not show the preventive effect of estriol against osteoporosis.

Estriol can be a safe and effective alternative in the relief of climacteric symptoms for postmenopausal women, but it cannot prevent the bone loss.