Effects of tibolone and continuous combined hormone replacement therapy on bleeding rates, quality of life and tolerability in postmenopausal women.
OBJECTIVE
To compare the effects of tibolone and conjugated equine oestrogens continuously combined with medroxyprogesterone acetate on bleeding rates, quality of life (QoL) and tolerability.


METHODS
A double-blind, randomised comparative trial.


METHODS
Thirty-seven centres in six European countries.


METHODS
Five hundred and one postmenopausal women, under 65 years of age with an intact uterus.


METHODS
For 12 months, women received daily treatment with tibolone 2.5 mg (n = 250), or conjugated equine oestrogens 0.625 mg continuously combined with medroxyprogesterone acetate 5 mg (CEE-MPA, n = 251).


METHODS
The primary outcome was vaginal bleeding rate during cycles 4-6. The secondary outcomes were vaginal bleeding rate during cycles 1-3, 7-9 and 10-13, cumulative bleeding rate, QoL, wellbeing, climacteric symptoms, urogenital complaints and tolerability.


RESULTS
Treatment with tibolone led to a significantly lower bleeding rate during cycles 4-6 compared with CEE-MPA (15.0% vs 26.9%; P = 0.004); there was a similar difference during cycles 1-3. Both treatments improved QoL, wellbeing, climacteric symptoms and urogenital complaints. By intent-to-treat analysis, tibolone significantly improved sexual drive, interest and/or performance, compared with CEE-MPA at 12 months (P = 0.017). Although both treatments were well tolerated, there was a significantly lower incidence of breast tenderness with tibolone than CEE-MPA (2.4% vs 17.1%; P < 0.001).


CONCLUSIONS
The vaginal bleeding rate during cycles 4-6 was significantly lower in women using tibolone. Both treatments improved QoL, wellbeing, climacteric symptoms and urogenital symptoms. Breast tenderness was significantly less frequent with tibolone.
Huber
J
J
Menox Institute, Vienna, Austria.
Palacios
S
S
Berglund
L
L
Hänggi
W
W
Sathanandan
S M
SM
Christau
S
S
Helmond
F
F
D004338:Drug Combinations; D020847:Estrogen Receptor Modulators / Q000008:administration & dosage*; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D008525:Medroxyprogesterone / Q000008:administration & dosage*; D008875:Middle Aged; D009652:Norpregnenes / Q000008:administration & dosage*; D011788:Quality of Life; D014592:Uterine Hemorrhage / Q000517:prevention & control*
D004338:Drug Combinations; D020847:Estrogen Receptor Modulators; D004967:Estrogens; D009652:Norpregnenes; C027385:tibolone; D008525:Medroxyprogesterone