Chlormadinone acetate versus micronized progesterone in the sequential combined hormone replacement therapy of the menopause

The impact of micronized progesterone on the endometrium: a systematic review

“…Endometrial biopsies were performed in 17 studies [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] of which eight were RCTs 12,13,15,17,18,21,22,24 including two placebo-controlled RCTs 15, 21 . Endometrial biopsy procedure was described by all but six authors 12,13,16,20,21,25 .…”

“…Endometrial biopsy procedure was described by all but six authors 12,13,16,20,21,25 . The majority either used a pipelle de Cornier 14,15,18,22,24,26 or Novak's curette 14,15,18,22,26 . Others used a needle aspiration (pistolet method) 23 , vabra suction curettage 10,11,15,19 or performed a conventional dilatation and curettage 17,19 .…”

“…Conjugated equine estrogens (CEE) were the most common estrogen component of menopausal hormone therapy (MHT) while others used 17b-estradiol. Estrogen dosage was either high-dose 14,17,19 , standard-dose [10][11][12][13][14][15][16]18,20,[22][23][24][25][26] , low-dose 25 or ultra-low-dose 21 . Estrogens were applied either orally or transdermally.…”

“…Estrogens were applied either orally or transdermally. MP was examined either at different dosages ranging from 50 mg/ day 12 , 100 mg/day [10][11][12]14,19,21,[24][25][26] , 200 mg/day 9,13,[15][16][17][18][19][20]22,23 , 300 mg/day 14,16,17,19,24 to 400 mg/day 24 or compared to other progestins (intrauterine levonorgestrel (LNG) 23 , oral chlormadinone acetate (CMA) 18,22 ,oral MPA 15,16 ). The regimen of combined MHT differed, ranging from continuously combined MHT (28 days per cycle/whole month), intermittently combined MHT (25 days per cycle followed by a 5-day hormone break) to sequentially combined MHT (continuous estrogen therapy combined with a progestogen for 10-14 days per cycle/month).…”

“…Histomorphology was the most common method used to differentiate between proliferative, secretory and atrophic endometrium [10][11][12][13][14][16][17][18][19][20][22][23][24][25][26] , and, if applicable, normal, hyperplastic and cancerous endometrium 10,11,15,[19][20][21]24 . Treatment success may be defined as yielding an atrophic, inactive or secretory endometrium whereas treatment failure corresponds to a proliferative endometrium response or hyperplasia 22 . In addition, some investigators assessed histomorphometry 17 , mitotic count 14,26 , mitotic index 20 , DNA synthesis 26 , proliferation index (MIB) 24 , or used transmission electron microscopy and biochemistry markers 19 .…”