Induction of amenorrhea during hormone replacement therapy: optimal micronized progesterone dose. A multicenter study.
The effects of oral micronized progesterone on the endometrium and bleeding pattern have been assessed in a multicenter study of 101 postmenopausal patients. During a minimum of 6 cycles, the participants received either percutaneous 17 beta-estradiol (1.5 mg/day) associated with micronized progesterone (100 mg/day), given at bedtime for 21/28 days or 25 days/calendar month (n = 98) [1], or E2 (3 mg/day) for 25 days associated with progesterone (300 mg/day), from day 16 to day 25 (n = 3) [2], according to their willingness to induce, or not, cyclic withdrawal bleeding. Each endometrial biopsy performed at 6-month minimum was assessed by two independent pathologists: results showed 61% quiescent without mitosis, 23% mildly active with very rare mitoses and 8% partial secretory endometrium. The remaining biopsies showed inadequate tissue (4%) or a sub-atrophy (4%). No hyperplasia was found by any pathologist. In the case of inadequate material, the mean thickness of endometrial mucosa measured by ultrasonography was 3.9 mm. Amenorrhea incidence was 93.3 and 91.6% at the 3rd and 6th month of therapy, respectively. No bleeding occurred in more than 80% of women. The results show that a low dose of oral progesterone (100 mg/day), given during 25 days, efficiently protects the endometrium by fully inhibiting mitoses and induces amenorrhea in the majority of postmenopausal women, allowing better compliance to long-term therapy.
Department of Gynecology and Obstetrics of Saint Roch Hospital, Nice, France.
J Y
JY
Gillet
G
G
Andre
B
B
Faguer
R
R
Erny
M
M
Buvat-Herbaut
M A
MA
Domin
J M
JM
Kuhn
B
B
Hedon
E
E
Drapier-Faure
J
J
Barrat
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000568:Amenorrhea; D004717:Endometrium / Q000166:cytology / Q000187:drug effects; D004958:Estradiol / Q000008:administration & dosage; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D011374:Progesterone / Q000008:administration & dosage*
D011374:Progesterone; D004958:Estradiol