title: A novel regimen of combination transdermal estrogen and intermittent vaginally administered progesterone for relief of menopausal symptoms.
abstract: 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.
authors.affiliation: Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. jamie.kroft@utoronto.ca
authors.forename: Jamie
authors.initials: J
authors.lastname: Kroft
authors.forename: Natalie R
authors.initials: NR
authors.lastname: Klostermann
authors.forename: Joel R K
authors.initials: JR
authors.lastname: Moody
authors.forename: Evan
authors.initials: E
authors.lastname: Taerk
authors.forename: Wendy
authors.initials: W
authors.lastname: Wolfman
mesh_terms: 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
chemical_list: D011374:Progesterone; D004958:Estradiol