Bleeding profiles and effects on the endometrium
for women using a novel combination of
transdermal oestradiol and natural progesterone
cream as part of a continuous combined hormone
replacement regime.
Vashisht A, Wadsworth F, Carey A, Carey B, Studd
J.
Chelsea and Westminster Hospital, London, UK.
Objectives:
Many women are seeking alternatives
to conventional forms of hormone replacement.
This study evaluates the endometrial effects of
natural progesterone cream used in conjunction
with transdermal oestradiol.
Design:
Open plan
study conducted over 48 weeks.
Setting:
Tertiary
referral London teaching hospital. POPULATION:
Women at least two years postmenopausal.
Methods:
Women were recruited nationally. They
applied 40 mg transdermal natural progesterone
cream and 1 mg transdermal oestradiol daily.
MAIN OUTCOME MEASURES: Endometrial histology,
assessed by pipelle endometrial biopsy,
ultrasound assessment of endometrial thickness
and bleeding diaries.
Results:
Fifty-four women
were recruited of which 41 completed the study.
Mean age was 57.4 years. Thirty-two percent of
women had evidence of inadequate endometrial
opposition (proliferative or hyperplastic) at
the end of 48 weeks. At baseline, women had a
mean endometrial thickness of 3.3 mm, which had
significantly thickened to a mean of 5.3 mm by
24 weeks (P < 0.001). By 48 weeks, there was
significantly greater increase in endometrial
thickness from baseline in those women who
displayed inadequate endometrial opposition,
compared with those women who had adequate
endometrial opposition (P= 0.004). At 24 weeks,
48% of women had remained entirely amenorrhoeic.
By the end of the study, 35% of women had been
entirely amenorrhoeic and 50% had had either no
bleeding or spotting alone. The number of
bleeding episodes did not reduce with time.
Conclusions:
The dose of natural progesterone
cream in this study was insufficient to fully
attenuate the mitogenic effect of oestrogen on
the endometrium. We would not recommend this
combination of hormones to be used by
postmenopausal women.
The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.
