Endometrial safety and bleeding with HRT: what's new?
- 1 January 2007
- journal article
- review article
- Published by Informa UK Limited in Climacteric
- Vol. 10 (sup2), 66-70
- https://doi.org/10.1080/13697130701546125
Abstract
There have been few additional published data concerning the effects of hormone replacement therapy (HRT) on the endometrium since December 2003. The Million Women Study has confirmed the known protective effect of progestogen with both sequential and continuous combined regimens, although also reporting an increased risk of endometrial cancer with tibolone. This finding has not been found in any other study previously or in the recently reported OPAL 3-year study. Bleeding during HRT remains an important issue for patient acceptability as well as physician concern about the implications. The incidence of bleeding is related to the dose of estrogen and the development of new low-dose therapies containing 0.5 mg oral estradiol, 0.3 mg oral conjugated equine estrogens or 14 microg estradiol daily by transdermal patch is associated with less bleeding and thus greater patient acceptability as well as minimal endometrial stimulation. Intrauterine delivery of progestogen is the most logical route of administration and provides a high level of progestogen directly to the endometrium, with good endometrial suppression and lower circulating levels than by other routes. The protective effect of progestogen on the endometrium has to be balanced against the apparent adverse effect on breast cancer risk.Keywords
This publication has 17 references indexed in Scilit:
- Neutral effect of ultra-low-dose continuous combined estradiol and norethisterone acetate on mammographic breast densityClimacteric, 2007
- Ultra-low-dose estradiol and norethisterone acetate: effective menopausal symptom reliefClimacteric, 2007
- Effects of Tibolone and Continuous Combined Conjugated Equine Estrogen/Medroxyprogesterone Acetate on the Endometrium and Vaginal Bleeding: Results of the OPAL StudyAmerican Journal of Obstetrics and Gynecology, 2006
- Endometrial effects, bleeding control, and compliance with a new postmenopausal hormone therapy regimen based on transdermal estradiol gel and every-other-day vaginal progesterone in capsules: a 3-year pilot studyFertility and Sterility, 2005
- Uterine and Vaginal Effects of Unopposed Ultralow-Dose Transdermal EstradiolObstetrics & Gynecology, 2005
- Effects of Estrogen Plus Progestin on Gynecologic Cancers and Associated Diagnostic ProceduresThe Women's Health Initiative Randomized TrialJAMA, 2003
- Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled TrialJAMA, 2002
- The assessment of bleeding patterns in postmenopausal women during continuous combined hormone replacement therapy: a review of methodology and recommendations for reporting of the dataClimacteric, 2002
- A double‐blind, randomised trial comparing the effects of tibolone and continuous combined hormone replacement therapy in postmenopausal women with menopausal symptomsBJOG: An International Journal of Obstetrics and Gynaecology, 1998
- Increased Risk of Endometrial Carcinoma among Users of Conjugated EstrogensNew England Journal of Medicine, 1975