Analysis of menstrual calendars and serum alpha 2-PEG in women on hormone replacement therapy for 12 months.
This study was conducted to assess endometrial protection in women on a cyclical combined hormone replacement regimen with 1 mg norethisterone BP, and to evaluate the use of the bleeding pattern and serum alpha 2-PEG in monitoring the endometrial response to exogenous hormone therapy. Fifty-one postmenopausal women attending the Menopause Research Unit at Leicester Royal Infirmary, UK, completed the study. All patients were at least 1 year after the menopause, with an average of 26 months since the last menstrual period. All women were prescribed a regimen of two tablets of Hormonin (oestriol 0.27 mg, oestrone 1.4 mg, and oestradiol 0.6 mg) continuously, with 1 mg of norethisterone added for 12 days out of each 28-day treatment cycle. Menstrual diaries were collected and analysed. The secretory changes were assessed by histology, menstrual bleeding pattern and a biological marker of secretory activity (alpha 2-PEG). Withdrawal bleeding occurred on average on days 11, 12, 11, 12 and 13 on months 2, 3, 6, 9 and 12, respectively. There was a poor degree of consistency in the bleeding pattern. The level of alpha 2-PEG increased from the average baseline measurement of 2.7 ng/ml (S.D., 4.12) to 8.5 ng/ml (S.D., 4.16) after progestogen treatment. This rise, although significant, did not correlate with the uterine bleeding pattern. There was no statistically significant correlation between the level of alpha 2-PEG and endometrial histology. The findings highlight the fact that cycle predictability on HRT, as exemplified in this regimen, is poor. The level of alpha 2-PEG is a poor predictor of the endometrial histology and has a poor correlation with the day of onset of bleeding.
Habiba
M
M
Department of Obstetrics and Gynaecology, Leicester University School of Medicine, Leicester Royal Infirmary, UK.
al-Azzawi
F
F
D000328:Adult; D004963:Estrenes / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy; D005260:Female; D000071816:Glycodelin; D006023:Glycoproteins; D006801:Humans; D008597:Menstrual Cycle / Q000187:drug effects / Q000502:physiology*; D008598:Menstruation / Q000502:physiology; D008875:Middle Aged; D009640:Norethindrone / Q000627:therapeutic use*; D010349:Patient Compliance; D017698:Postmenopause / Q000097:blood*; D011257:Pregnancy Proteins / Q000097:blood*; D013997:Time Factors
D004963:Estrenes; D000071816:Glycodelin; D006023:Glycoproteins; C045246:PAEP protein, human; D011257:Pregnancy Proteins; D009640:Norethindrone