A randomized, double-blind, placebo-controlled, cross-over trial to assess the side effects of medroxyprogesterone acetate in hormone replacement therapy

Article Abstract:

Postmenopausal women are often given estrogen replacement therapy to prevent the side effects and changes associated with menopause, including hot flushes, sleep problems, and urogenital tract changes. This therapy also helps to prevent osteoporosis (bone loss) and heart disease. On the other hand, it increases the risk for endometrial carcinoma, or cancer of the mucous membrane that lines the inner wall of the uterus. This side effect can be prevented by giving a progestational agent, such as medroxyprogesterone acetate, with estrogen replacement therapy. However, this progestational drug may cause some minor side effects such as bloating, constipation, fatigue, and irritability. These are fairly minor complications unless they result in patients not complying with their replacement therapy. This study examined the side effects of medroxyprogesterone acetate to see if they were significant enough to result in noncompliance with replacement therapy. Forty-eight women who underwent hysterectomies were placed on identical estrogen replacement therapies. Twenty-four of the women had suffered severe symptoms of premenstrual syndrome (PMS) prior to surgery; the other 24 had not had this problem. Medroxyprogesterone acetate was given to half the women in each group for the first half of the study and then to the other women for the remainder of the study. Mood and physical symptoms were recorded. These results showed that the women in both groups experienced no differences when they did or did not receive medroxyprogesterone acetate with replacement therapy. Personal preferences were equally divided in both groups between the periods with and without the drug. These results indicate that at the dosage given and for the time period of the study, medroxyprogesterone acetate did not cause consistent adverse side effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Hormone therapy, Menopause, Medroxyprogesterone

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Lasting response to ovariectomy in severe intractable premenstrual syndrome

Article Abstract:

Although most women have physiological and emotional experiences which alert them to the impending onset of menstruation, in some women these experiences interfere with normal activities and interpersonal relationships. In some patients this premenstrual syndrome (PMS) may be severe and unresponsive to conventional management. In a study of 14 women with severe, intractable PMS, the ovaries were surgically removed to eliminate the apparent source of the endocrine dysfunction. The women were initially treated with danazol at a dosage sufficient to suppress menstruation. This dosage was continued for nine months to assure that ovarian suppression would indeed relieve symptoms in these patients. When danazol therapy was stopped, the PMS symptoms returned, and the women were offered the option of having both ovaries removed. The simultaneous removal of the uterus was recommended, as the cyclic hormonal therapy, necessary for maintaining the uterus in the absence of ovaries, may also elicit the return of some PMS-like symptoms. Estrogen replacement therapy is necessary after ovariectomy to reduce both short-term side effects, such as sleep disturbance and vaginal atrophy, and long-term side effects, such as osteoporosis and heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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The effect of hysterectomy and bilateral oophorectomy in women with severe premenstrual syndrome

Article Abstract:

Although up to 30 percent of women experience moderate to severe premenstrual syndrome (PMS), about 5 percent have such severe symptoms that PMS constitutes a major disruption in their lives. The precise cause of PMS is unknown, and a specific treatment is not available. It is clear, however, that the symptoms of PMS are linked to the monthly cycle of steroid hormones produced by the ovaries. Drugs like danazol may prevent PMS by suppressing ovulation, but side effects preclude their long-term use. Previous studies have shown that hysterectomy, or surgical removal of the uterus, is not sufficient for the alleviation of PMS. In a study involving 14 women with severe PMS, hysterectomy and oophorectomy, or removal of the ovaries, resulted in an improvement in psychological test scores, indicating an increased satisfaction in life, more positive sense of well-being, and overall quality of life. The women's psychological scores six months after hysterectomy and oophorectomy were similar to those observed in the population as a whole. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects

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