[Progestin treatments of menopause]

Hormone replacement therapy is prescribed to post-menopausal women in order to correct oestrogen deficiency and its short- or long-term consequences. Progestogens are combined with oestrogens to prevent the proliferative effect of the latter on the endometrium. There are three classes of progestogens: normethyl testosterone derivatives, pregnanes and norpregnanes, and natural progesterone. The usual choice is either natural progesterone or 17-hydroxyprogesterone derivatives which do not carry metabolic or vascular risks. The endometrium is protected by simple therapeutic rules: the doses of oestradiol must be minimal to prevent osteoporosis, and this product must not be administered alone for a sequence longer than 13 days. The progestogen sequence must last for 12 days. The wide range of progestogens available in France enables individual adjustments to be made. Using progestogens alone could be interesting in women from whom oestrogenic treatments are contraindicated, in view of their effect on sudden flush and on bone.