A novel regimen of combination transdermal estrogen and intermittent vaginally administered progesterone for relief of menopausal symptoms.
OBJECTIVE
To determine the safety and efficacy of a novel regimen of transdermal estrogen and vaginally administered progesterone for treatment of menopausal symptoms.


METHODS
A retrospective chart review was conducted of menopausal patients aged 46-65, using an oestradiol patch and vaginally administered prometrium for at least 1 year. Available transvaginal ultrasound (TVUS) measurements of endometrial thickness and endometrial biopsy results after at least 1 year of treatment were collated. Symptom relief, bleeding and side effects were reviewed.


RESULTS
Forty-one patients were identified, using an estrogen patch ranging from 25 to 100 μg twice weekly and vaginal prometrium either continuously 3-5 days weekly (36 patients), or sequentially 12 days/month (5 patients). Seventeen patients were lost to follow-up or discontinued therapy within 1 year. Only 23.5% (4/17 patients) of patients who had a TVUS after 1 year (or sooner if bleeding occurred) had a thickened endometrial lining on ultrasound (>5 mm), and all of these had normal endometrial biopsies. By 1 year of follow-up, 91.7% of patients were amenorrhoeic. All patients had relief of menopausal symptoms.


CONCLUSIONS
Vaginal administration of progesterone as part of combined estrogen plus progestin therapy has the potential for decreasing side effects while maintaining endometrial safety and amenorrhoea. Larger prospective trials are warranted.
Kroft
Jamie
J
Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. jamie.kroft@utoronto.ca
Klostermann
Natalie R
NR
Moody
Joel R K
JR
Taerk
Evan
E
Wolfman
Wendy
W
D000279:Administration, Cutaneous; D000282:Administration, Intravaginal; D000368:Aged; D004717:Endometrium / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D004958:Estradiol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008593:Menopause / Q000187:drug effects*; D008875:Middle Aged; D011374:Progesterone / Q000008:administration & dosage*; D012189:Retrospective Studies; D014463:Ultrasonography
D011374:Progesterone; D004958:Estradiol