Comparison of continuous versus sequential estrogen and progestin therapy in postmenopausal women

Article Abstract:

Estrogen (a female hormone) replacement therapy relieves menopausal symptoms such as hot flashes, vaginal discomfort, and loss of bone density. It is usually combined with a monthly short (up to 13 days) course of progestin (another female hormone) to decrease the likelihood of estrogen-related endometrial cancer (of the uterine lining). However, certain side effects are associated with this regimen, such as monthly bleeding. To compare the effects of continuous versus sequential administration of these hormones, a three-month pilot study was carried out of the two most commonly prescribed drugs for ovarian hormone replacement, conjugated equine estrogen and medroxyprogesterone acetate. Forty-five women were randomly assigned to one of four groups: two groups were 'continuous', in which estrogen and the progestin were taken continuously but two different doses of estrogen were prescribed (0.625 or 1.25 milligrams); and two were 'sequential', in which estrogens (at the same two doses as were given to the continuous groups) were taken from days 1 through 25 and the progestin from days 16 to 25. Women taking the higher estrogen dose experienced more days of bleeding than those taking the lower dose, and more women in the continuous, high-dose group experienced no bleeding than in the sequential groups. Endometrial biopsy samples showed significantly more atrophy (wasting) in women from the continuous, high-dose group, while endometrial proliferation (a phase of the normal menstrual cycle) was observed more often in women from the sequential, low-dose group. Blood levels of cholesterol decreased significantly in patients in the sequential group, while blood triglyceride (fat) levels rose in women in the continuous group. The results indicate that progestin given continuously with estrogen may lead to cessation of bleeding, but that some of estrogen's protective benefits against coronary artery disease may be lost. Lower doses of the progestin may not have similar effects on blood lipids, and are currently being studied. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Measurement, Postmenopausal women, Lipoproteins, Drug therapy, Combination, Combination drug therapy, Blood lipoproteins

---

Treatment of endometriosis with a long-acting gonadotropin-releasing hormone agonist plus medroxyprogesterone acetate

Article Abstract:

Endometriosis is a condition in which bits of uterine lining are abnormally located in the pelvic cavity or on the abdominal wall and cause pain and discomfort, especially during menstruation and intercourse. It can be treated by the administration of an agonist of gonadotropin-releasing hormone (GnRH), a drug with the same actions as gonadotropin-releasing hormone, but uncomfortable side effects occur, including hot flashes and loss of calcium from bone. (Gonadotropin-releasing hormones stimulate the gonads, in this case the ovaries, to produce female hormones.) To evaluate the effects of a different drug regimen, eight women were studied, each of whom had at least five implants (sites) of endometriosis and received a GnRH agonist and medroxyprogesterone acetate (MPA, another female hormone). The subjects underwent laparoscopy (viewing the internal female organs through a fiber optics tube) before and after the course of medication, which lasted for 24 weeks. Two investigators evaluated the photographs of all endometrial implants for the extent of disease; this constituted the American Fertility Society score. The investigators were uninformed as to when in the course of treatment the photographs had been taken. Symptoms, such as hot flashes, were monitored, and bone scans were performed to determine bone density. Results for the seven subjects who completed the course were compared with results from 16 patients with endometriosis who previously took only the GnRH agonist. GnRH alone reduced pelvic pain scores and the number of implants to a greater extent than GnRH plus MPA. However, patients on the combined therapy complained less of hot flashes than patients on GnRH alone and experienced less bone loss. Overall, although MPA plus a GnRH agonist relieved some symptoms associated with the GnRH agonist alone, it was at the expense of pain relief and reduction of the number of implants. A drug treatment for endometriosis that does not cause undesirable side effects remains elusive. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gonadotropin, Gonadotropins, Gonadotropin releasing hormone, Gonadorelin, Endometriosis

---

Pathogenesis, prevention, and treatment of osteoporosis

Article Abstract:

Osteoporosis (a decrease in bone mass) ultimately affects most postmenopausal women, and the fractures of wrist, vertebrae, and hip with which it is associated carry a high mortality. Osteoporotic bones break, however, only after the disease has been present for some time. The pathogenesis and prevention of osteoporosis are reviewed. The difference between peak adult bone mass and bone loss is the bone density; peak adult bone mass is mostly genetically determined, while the extent of bone loss after menopause depends on hormonal levels. Thus, a woman with a high peak adult bone mass can lose 20 percent of bone after menopause without falling below the bone density threshold where fracture is likely, whereas a woman with lower peak adult bone mass will fall below the threshold soon after menopause. Although bone mass is primarily genetically controlled, it can be negatively affected by alcohol and cigarette smoking. Calcium intake, intense nutritional efforts, or exercise do not appear to affect peak adult bone density after the bones have stopped growing. After menopause, bone loss is the consequence of hormonal changes, and is affected by the time since menopause, the number of pregnancies (the more, the greater the bone density), and previous use of oral contraceptives (which improves bone density). Calcium does not appear to reduce bone loss. Bone loss after menopause can be prevented by the administration of estrogen, which should be instituted as early as possible. If significant bone loss and fracture have already occurred, slower bone loss or bone formation can be induced by drug therapy. Disodium etidronate appears to slow the rate of loss, while anabolic steroids and fluoride stimulate bone formation. Reducing the rate of bone loss by hormone replacement therapy could prevent fractures and save lives on a large scale. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Development and progression, Osteoporosis

Similar abstracts:

• Abstracts: The role of vaginal scan in measurement of endometrial thickness in postmenopausal women. Changes in circulating alphafetoprotein following administration of mifepristone in first trimester pregnancy
• Abstracts: Oestrogens, joint disease, and cartilage. Effects of cyclical etidronate combined with calcitriol versus cyclical etidronate alone on spine and femoral neck bone mineral density in postmenopausal osteoporotic women
• Abstracts: A 1-year walking program and increased dietary calcium in postmenopausal women: effects on bone. Calcium supplementation and bone loss: a review of controlled clinical trials
• Abstracts: Economic barriers to the use of oral rehydration therapy: a case report. Poverty medicine
• Abstracts: Regulation of the immune response to Candida albicans by monocytes and progesterone. part 2 Endotoxin-induced cytokine production of monocytes of third-trimester pregnant women compared with women in the follicular phase of the menstrual cycle

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