title: Hormone replacement therapy and vigilance: double-blind, placebo-controlled EEG-mapping studies with an estrogen-progestogen combination (Climodien, Lafamme) versus estrogen alone in menopausal syndrome patients.
abstract: The aim of the double-blind, placebo-controlled study was to investigate the effects of a continuous combined estrogen-progestogen treatment (Climodien, Lafamme) as compared with estrogen alone on vigilance in insomniac postmenopausal syndrome patients, objectified by EEG mapping.
  
  
  METHODS
  In a 3-arm, 2-month parallel group design phase, patients received a combination of estradiol valerate 2 mg and the novel progestogen dienogest 3 mg (Climodien 2/3) or estradiol valerate 2 mg alone or placebo. In a subsequent open-label phase, all patients received estradiol valerate 2 mg+dienogest 2 mg (Climodien 2/2). EEG mapping was carried out before and after the 2-month double-blind phase as well as after the 2-month open-label treatment.
  
  
  RESULTS
  As compared with placebo, Climodien 2/3 induced a marked and highly significant increase in absolute power in all frequency bands, specifically in alpha-2 activity. Moreover, a significant increase in relative alpha-2 power, a decrease in relative delta and beta power as well as an acceleration of the dominant frequency and of the delta and alpha centroids suggested a marked improvement in vigilance. In contrast, under estradiol valerate 2 mg alone, only a slight augmentation of alpha and attenuation of relative delta and beta power occurred, suggesting only a slight vigilance improvement as compared with placebo. Thus, dienogest 2 mg increased the estrogen effect, which was also confirmed by a statistical evaluation of the differences between Climodien 2/3 and estradiol valerate alone (augmentation of alpha-2, attenuation of relative beta, acceleration of the dominant frequency). Moreover, Climodien 2/2 also markedly increased alpha-2 power, decreased relative beta-2 power and accelerated the alpha centroid. Finally, comparing Climodien 2/3 with Climodien 2/2, there was even a dose-efficacy relation.
  
  
  CONCLUSIONS
  Estradiol valerate 2 mg improves vigilance slightly, thereby confirming previous findings. The additional administration of dienogest does not minimize the effect of estrogen, but on the contrary increases it, which makes the combination superior to both placebo and estradiol valerate alone. Vigilance improvement may be of great therapeutic benefit to menopausal syndrome patients at a time when increased adaptability is needed to adjust to increasing sexual, marital, occupational and social difficulties known to occur specifically in this period of life.
authors.affiliation: Department of Psychiatry, University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria. bernd.saletu@akh-wien.ac.at
authors.forename: Bernd
authors.initials: B
authors.lastname: Saletu
authors.forename: Peter
authors.initials: P
authors.lastname: Anderer
authors.forename: Doris
authors.initials: D
authors.lastname: Gruber
authors.forename: Markus
authors.initials: M
authors.lastname: Metka
authors.forename: Johannes
authors.initials: J
authors.lastname: Huber
authors.forename: Gerda M
authors.initials: GM
authors.lastname: Saletu-Zyhlarz
mesh_terms: D000368:Aged; D001143:Arousal / Q000187:drug effects*; D001931:Brain Mapping; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004569:Electroencephalography / Q000187:drug effects; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology* / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009277:Nandrolone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology* / Q000627:therapeutic use; D017698:Postmenopause; D012893:Sleep Wake Disorders / Q000188:drug therapy; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: C023635:dienogest; D004958:Estradiol; D009277:Nandrolone