Respiratory insufficiency in postmenopausal women: sustained improvement of gas exchange with short-term medroxyprogesterone acetate.
OBJECTIVE
The degree and duration of respiratory stimulation of medroxyprogesterone acetate (MPA) in postmenopausal women.


METHODS
A placebo-controlled single-blind trial.


METHODS
University hospital in Turku, Finland.


METHODS
Fourteen postmenopausal women with permanent or previous episodic hypercapnic or hypoxemic respiratory failure.


METHODS
A 12-week trial including 14-day treatment periods with placebo and MPA (60 mg daily) and a 6-week follow-up.


RESULTS
Thirteen of 14 patients completed the trial. The mean (+/- SD) PaCO2 at baseline was 42.8+/-4.5 mm Hg and the mean PaO2 was 71.2+/-9.0 mm Hg. The average reduction of PaCO2 was 6.3 mm Hg (14.7%, p < 0.001) on MPA and 3.0 mm Hg (6.1%, p = 0.001) after a 3-week washout. At 6 weeks after MPA, the PaCO2 had returned to baseline. The mean changes in PaO2 (+6.0+/-18.0 mm Hg on MPA and +3.8+/-22.5 mm Hg after a 3-week washout) were not significant. The PaO2/PaCO2 ratio increased, and bicarbonate and base excess decreased (p < 0.001) on MPA but not during washout. The systolic BP did not change on MPA but decreased on average 14.8+/-15.0 mm Hg (p = 0.016) after a 3-week washout. The diastolic BP remained unchanged.


CONCLUSIONS
Our results suggest that postmenopausal women with chronic respiratory insufficiency consistently improve on MPA at a dose of 60 mg daily for 14 days. Lower PaCO2 is sustained for at least 3 weeks after cessation of MPA. The sustained effects in gas exchange and favorable after-effects in BP warrant further studies into the therapeutic efficacy and possible benefits of MPA pulse therapy.
Saaresranta
T
T
Department of Pulmonary Diseases, Turku University Hospital, Finland. saaresrt@mars.tyks.fi
Polo-Kantola
P
P
Irjala
K
K
Helenius
H
H
Polo
O
O
D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006728:Hormones / Q000097:blood; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D008875:Middle Aged; D017698:Postmenopause; D045167:Progesterone Congeners / Q000627:therapeutic use*; D011659:Pulmonary Gas Exchange / Q000187:drug effects*; D012131:Respiratory Insufficiency / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D006454:Hemoglobins; D006728:Hormones; D045167:Progesterone Congeners; D017258:Medroxyprogesterone Acetate