Digitized assessment of mammographic breast density in patients who received low-dose intrauterine levonorgestrel in continuous combination with oral estradiol valerate: a pilot study.
OBJECTIVE
To perform a pilot study of the effects on the breast by low-dose intrauterine progestogen combined with estrogen.


METHODS
A prospective pilot study.


METHODS
University hospital.


METHODS
Twenty postmenopausal women without any previous breast disorder.


METHODS
Women were treated with a low-dose intrauterine system releasing 20 microg/24 hours of levonorgestrel in continuous combination with 2 mg of oral E2 valerate. The effects on mammographic breast density, breast cell proliferation, and hormonal levels were followed for 18 months.


METHODS
Change in mammographic breast density and breast cell proliferation. Correlations with levels of hormones, growth factors, and binding proteins.


RESULTS
Three women showed an apparent increase in density. For the remaining 17 women the changes were only a few percent. Digitized assessment of density showed strong correlations with visual classification scales (rs = 0.96-0.97). There was no increase in proliferation as expressed by the percentage of MIB-1-positive breast cells in fine-needle aspiration biopsies. Increase in breast density displayed a positive correlation with patients age (rs = 0.52) and an inverse relationship with levels of E2 (rs = -0.50) and free T (rs = -0.50).


CONCLUSIONS
Low-dose intrauterine administration progestogen may develop into an attractive alternative for hormonal therapy in postmenopausal women as endometrial protection may be achieved at very low systemic levels.
Department of Obstetrics and Gynecology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden. eva.lundstrom@karolinska.se
Eva
E
Lundström
Gunnar
G
Söderqvist
Gunilla
G
Svane
Edward
E
Azavedo
Matts
M
Olovsson
Lambert
L
Skoog
Eva
E
von Schoultz
Bo
B
von Schoultz
D000284:Administration, Oral; D000368:Aged; D001940:Breast / Q000166:cytology / Q000187:drug effects*; D049109:Cell Proliferation; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015914:Estrogen Replacement Therapy / Q000379:methods; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D014599:Uterus
D004338:Drug Combinations; D004958:Estradiol; D016912:Levonorgestrel