Can the withdrawal bleed following oestrogen replacement therapy be avoided?

Article Abstract:

Treatment with the hormone estrogen can relieve symptoms of menopause and decrease the incidence of osteoporosis (bone loss) and heart disease. However, estrogen may cause endometrial hyperplasia, the excessive proliferation of cells in the endometrium (the inner lining of the uterus). Endometrial hyperplasia may be associated with the development of cysts, irregular heavy bleeding, or an increased risk for cancer. The proliferative effect of estrogen can be prevented by progestogens, which induce withdrawal bleed in women with an intact uterus. However, progestogens may cause premenstrual-like symptoms, such as breast tenderness, nausea, irritability, water retention, and heavy, painful bleeding. Unfavorable metabolic changes may also occur, including decreases in high density lipoproteins and increases in low density lipoproteins; causing the loss of the protective effect of estrogens on the heart. These adverse effects may limit the use of estrogen therapy. Continuous combined estrogen and progestogen preparations have been shown to cause amenorrhea, the absence of uterine bleeding. A lower dose of estrogen and higher dose of progestogen can achieve amenorrhea more rapidly. This combined continuous hormone regimen has been shown to maintain the protective effect of estrogens on the heart and stimulation of bone formation. A small percentage of women may be able to use estrogen without progestogen, but they should be routinely assessed for abnormalities of uterine tissue. Other methods of destroying or removing portions of the endometrium to induce amenorrhea are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Physiological aspects, Progestational hormones, editorial

---

Quantitation of hormone replacement induced withdrawal bleeds

Article Abstract:

One complication postmenopausal women face when they take estrogen-progestogen supplements (hormone replacement therapy) is vaginal bleeding (withdrawal bleeding). To evaluate the amount of withdrawal bleeding associated with a newly developed hormone supplement, 50 women were studied during 12 treatment cycles. The drug combination consisted of continuous estradiol valerate, with the addition of levonorgestrel (a progestogen) for the last 12 days of each 28-day cycle. Withdrawal bleeding was defined as bleeding at the end of the progestogen phase, or at the start of the next cycle; it was measured at the 3rd, 6th, and 12th treatment cycles. Two women did not bleed at any point. The remainder lost between 17 and 26 milliliters (median or most common values) during the cycles that were studied: 13 percent experienced menorrhagia (excessive bleeding of more than 80 milliliters per episode). Bleeding began between days one and three of the cycle, and lasted from three to seven days. In five percent of the treatment cycles, bleeding occurred at another time, in addition to the withdrawal bleeding. The drug combination seemed to be well tolerated by the subjects, and blood loss was equivalent to that in premenopausal women (median, 35 milliliters). Additional studies would be needed to evaluate withdrawal bleeding after other hormone combinations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy

---

Mortality in a cohort of long-term users of hormone replacement therapy: an updated analysis

Article Abstract:

The death rates among women receiving long-term hormone replacement therapy (HRT) were assessed and compared with results from a previous and similar study. Death due to breast, ovarian, and uterine cancer; cardiovascular disease; and suicide or suspected suicide were examined, in particular. The present study involved 4,544 women who were recruited from centers specializing in the treatment of menopause. All of the women had been on HRT for at least one year. The overall death rate was lower among the women receiving HRT than the general population. However, the death rate from breast cancer was increased compared with previous studies. In addition, the risk of breast cancer appeared to rise with increasing duration of HRT. Death from heart and circulatory disease, ovarian and uterine cancer, and suicide were lower compared with previous results. These results support the protective effect of HRT against heart disease. However, the findings suggest that the death rate due to breast cancer may rise with increasing duration of HRT. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Mortality, Causes of, Breast cancer

Similar abstracts:

• Abstracts: Parenteral influence on food selection in young children and its relationships to childhood obesity. Safety of glutamine-enriched parenteral nutrient solutions in humans
• Abstracts: Lung function in children following empyema. Use of purified streptokinase in empyema and hemothorax. Passive smoke exposure impairs recovery after hospitalization for acute asthma
• Abstracts: Motherhood, employment and the development of depression: a replication of a finding? Symptoms and social adjustment in Jewish depressives
• Abstracts: Intracranial aneurysms: interventional neurovascular treatment with detachable balloons--results in 215 cases

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.