title: Factors associated with endometrial bleeding in continuous hormone replacement therapy.
abstract: OBJECTIVE
  To identify clinical and laboratory parameters associated with the occurrence of endometrial bleeding within the first 6 months of treatment in postmenopausal women taking continuous hormone replacement therapy.
  
  
  METHODS
  We performed a prospective study of 55 postmenopausal women who had amenorrhea for at least 12 months before baseline screening and were taking 0.625 mg conjugated estrogen and 5 mg medroxyprogesterone acetate daily on a continuous basis. Postmenopausal duration was defined as the interval, in months, between the last menstruation and the commencement of treatment. All subjects were instructed to monitor bleeding episodes in a diary and were followed up monthly for at least 12 months.
  
  
  RESULTS
  Thirty-four women (62%) experienced bleeding within the first 6 months of treatment. Using a multivariate approach, a woman with a postmenopausal duration of 24 months or less had a relative risk of 8.2 (95% confidence limits: 1.3, 53.1) of bleeding, as compared with those with a postmenopausal duration of more than 24 months. Furthermore, pretreatment endometrial thickness greater than 5 mm (p < 0.05) and serum estradiol levels greater than 25 pg/mL (p < 0.01) were noted to be significantly correlated with the occurrence of bleeding in women with a postmenopausal duration of more than 24 months.
  
  
  CONCLUSIONS
  Women with a postmenopausal duration of 24 months or less, a pretreatment endometrial thickness greater than 5 mm, and serum estradiol level greater than 25 pg/mL are at risk to have endometrial bleeding within the first 6 months of continuous hormone replacement therapy.
authors.affiliation: Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Shau
authors.forename: Ching-Chang
authors.initials: CC
authors.lastname: Hsieh
authors.forename: T'sang-T'ang
authors.initials: TT
authors.lastname: Hsieh
authors.forename: Tai-Ho
authors.initials: TH
authors.lastname: Hung
authors.forename: Kuo-En
authors.initials: KE
authors.lastname: Huang
mesh_terms: D000368:Aged; D004338:Drug Combinations; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000209:etiology*
chemical_list: D004338:Drug Combinations; D004966:Estrogens, Conjugated (USP); D017258:Medroxyprogesterone Acetate