Evaluation of low-dose estrogen and progestin therapy in postmenopausal women: A double-blind, prospective study of sequential versus continuous therapy

In this prospective, double-blind study, we evaluated the efficacy and safety of low-dose estrogen and progestin replacement therapy in 36 postmenopausal women who were administered oral medroxyprogesterone acetate (MPA) cyclically or continuously in combination with conjugated equine estrogen (CEE) 0.625 mg daily. In the sequential group, MPA (5.0 mg) was administered daily for 12 days of each 25-day treatment cycle. In the two continuous groups, MPA was administered without interruption at a daily dose of either 2.5 mg or 5.0 mg for 12 treatment cycles. Of the 36 women in the study, 29 women completed the one-year protocol. The clinical and metabolic responses were assessed before and every three cycles during the 12 cycles of treatment. Endometrial biopsies and lumbar bone density scans were performed before and during the last week of the 12th treatment cycle. Vasomotor and urogenital symptoms improved in all women. Cyclic menstrual bleeding occurred in all patients on sequential therapy, and proliferative endometrium was noted in two of these women. All patients in both continuous treatment groups experienced amenorrhea after the fifth cycle of therapy, and all endometrial biopsies were atrophic or inactive. From the 3rd through the 12th month of cycle, favorable lipid and lipoprotein changes occurred in all treatment groups. Lumbar bone mineral density improved significantly (P < .05) by an average of 6.41% in all patients. Although studies with a larger sample size and longer duration of observation are still needed, our data suggest that cyclic MPA therapy, even when administered for 12 days, reduces, but does not eliminate, the risk of endometrial proliferation and the possible adverse effects of unopposed estrogen and the continuous and combined daily use of CEE (0.625 mg) and MPA (2.5 mg) effectively relieves menopausal symptoms, induces amenorrhea in most patients, eliminates endometrial proliferation, induces favorable lipid and lipoprotein changes and improves lumbar bone mineral density in postmenopausal women.