Transdermal estrogen with a levonorgestrel-releasing intrauterine device for climacteric complaints versus estradiol-releasing vaginal ring with a vaginal progesterone suppository: clinical and endometrial responses.
OBJECTIVE
Our purpose was to compare the effects of a new estradiol-releasing vaginal ring with progesterone given as a vaginal suppository, versus the efficacy, safety and acceptability of an intrauterine device releasing levonorgestrel combined with estradiol, delivered transdermally from a patch. Climacteric symptoms, bleeding pattern and endometrial histologic features were studied.


METHODS
Fifty six parous, postmenopausal women with urogenital symptoms were allocated in two groups for one year: 28 women receiving estradiol by a vaginal ring and a 100 mg vaginal progesterone suppository 7 days every month and 28 women receiving a continuous transdermal daily dose of 50 micrograms of estradiol with a levonorgestrel-releasing intrauterine device inserted. All the patients were subjected to vaginosonographic examination followed by thorough pathological examination of the uterine curetting samples.


RESULTS
A mean endometrial thickness (double layer) of 2.9 and 3.0 mm, respectively, was found to be predictive of normal endometrium. Both treatment regiments effectively relieved climacteric symptoms. Endometrial proliferation was not observed. Spotting was more common in the intrauterine device group than in the vaginal ring group.


CONCLUSIONS
Treatment of urogenital symptoms in postmenopausal women with these two forms of hormone replacement therapy is shown to be an effective and safe method, exhibiting advantages over other methods of treatment.
Antoniou
G
G
2nd Department of Obstetrics and Gynecology, University of Athens, Areteion Hospital, Greece.
Kalogirou
D
D
Karakitsos
P
P
Antoniou
D
D
Kalogirou
O
O
Giannikos
L
L
D000279:Administration, Cutaneous; D000282:Administration, Intravaginal; D000368:Aged; D002979:Climacteric / Q000187:drug effects*; D004107:Dilatation and Curettage; D004359:Drug Therapy, Combination; D004717:Endometrium / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D004958:Estradiol / Q000008:administration & dosage* / Q000009:adverse effects; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D052776:Female Urogenital Diseases / Q000188:drug therapy; D006801:Humans; D007434:Intrauterine Devices; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000009:adverse effects; D008598:Menstruation / Q000187:drug effects; D008875:Middle Aged; D017698:Postmenopause / Q000187:drug effects; D011374:Progesterone / Q000008:administration & dosage* / Q000009:adverse effects; D012449:Safety; D013488:Suppositories; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology
D013488:Suppositories; D011374:Progesterone; D004958:Estradiol; D016912:Levonorgestrel