Lower Doses of Oral Estrogen and Progestogens as Treatment for Postmenopausal Women

Abstract

Estrogen, with or without a progestin, is effective for the treatment of menopausal symptoms. Larger doses of estrogen/progestin have been used than required for the amelioration of menopausal symptoms. Both positive and negative outcomes of hormone therapy are reported in postmenopausal women. The positive aspects have been those associated with a reduction in menopausal symptoms such as hot flashes, and improvement in vulvovaginal atrophy with maintenance of bone mineral density. The problems have included an increased risk of venous thrombosis and breast cancer. The anticipation is that as the dose of oral estrogen and progestins is lowered, the benefits can be maintained and the side effects reduced. Recent clinical trials have found that lower doses of estrogen and/or progestin reduce or improve menopausal symptoms and maintain bone mineral density. The impact of lower doses of hormones on heart disease, and venous thromboembolism and stroke remain to be determined in future studies.

Effects of the components of hormone therapy on matrix metalloproteinases in breast-cancer cells: an in vitro study

“…Additional characterization of the effects of the components of HT is warranted, based on these data. While low-dose studies will undoubtedly yield additional information, promoting one formulation over another may require additional research (27).…”

Pathophysiology and Treatment of Menopausal Hot Flashes

“…These issues are discussed in detail in the article by Dr. Archer in this volume. 70 Given that hot flashes are triggered by T c elevations 54,55 and are more frequent in warm environments, 52 procedures to reduce T c and ambient temperature are recommended. Dressing in layers, drinking cold drinks, and using fans and air conditioning should be attempted.…”

Care of the menopausal patient: A nurse practitioner’s view

“…Standard ET/EPT doses typically include CE 0.625 mg/ day and 17b-estradiol 1.0 mg/day (Table 3); however, evidence that lower estrogen doses provide benefits similar to those of standard-dose ET/EPT with fewer side effects is accumulating (Archer, 2005;Archer, Dorin, Lewis, Schneider, & Pickar, 2001;Lindsay et al, 2002;Pickar, Yeh, Wheeler, Cunnane, & Speroff, 2001;Utian, Shoupe, Bachmann, Pinkerton, & Pickar, 2001). Although longterm data on the safety of low-dose ET/EPT are needed, it is thought that low-dose HT may be associated with fewer risks than standard-dose HT (Archer;Lobo, 2004a).…”