Prevention of Postmenopausal Bone Loss and Endometrial Responses during a Two Year Prospective Study with Transdermal 17β‐Estradiol and Oral Medroxyprogesterine Acetate

Transdermal Estradiol

“…Addition of a progestational agent for 10 to 14 days per cycle reduces endometrial stimulation by estrogens, thus producing a more acceptable bleeding pattern as well as reducing the risk of hyperplasia (Clisham et al 1992;Gambrell 1978;). Endometrial hyperplasia was not observed in patients receiving cyclic or continuous transdermal estradiol 0.05 mg/day in combination with progestogens for 2 months to 2 years (Fioretti et al 1991;Johannisson et al 1988;Whitehead et al 1985Whitehead et al , 1990a, but occurred in 3 of 36 women receiving a higher transdermal estradiol dosage (0.1 mg/day) with medroxyprogesterone acetate 10 mg/day for 11 days per cycle (Lufkin et al 1992) and in 4 of 17 women receiving transdermal estradiol 0.05 mg/ day with only 2.5 mg/day medroxyprogesterone for 12 days per cycle (Castelo-Branco et al 1992) [see sections 3 and 4].…”

“…Comparisons between groups of postmenopausal women receiving transdermal estradiol for 18 months to 2 years and those receiving either placebo, no treatment or calcium supplements showed a bone-conserving effect of the estrogen regimen, as evidenced by a small but statistically significant increase in BMD in transdermal estradiol-treated women (approximately 4 to 5% in most studies), and a decrease in the comparison group (Adami et al 1989;Field et al 1992;Fioretti et al 1991;Ribot et al 1990; see table II). However, as with the noncomparative trials described previously, BMD was generally only measured at a single site, either the forearm or lumbar spine; moreover, it appears that most of these studies were not of randomised, prospective design, possibly because of ethical considerations.…”

“…BMD was measured by dual photon absorptiometry in almost all studies; additionally, Field et al (1992) used single photon absorptiometry to monitor BMC in the forearm. The stated reproducibility of the methods used was 1 to 2% (Adami et al 1989;Fioretti et al 1991;Marchesoni et al 1988;Stevenson et al 1990); however, the majority of investigators only monitored BMD at a single site.…”

“…Cutaneous reactions were the most common adverse events in 5 long term (1.5 to 2 years) clinical trials which evaluated transdermal estradiol in the prevention of osteoporosis (Adami et al 1989;Field et al 1992;Fioretti et al 1991;Ribot et al 1990;Stevenson et al 1990). Tolerability was reported to be very good in all of these studies; of 66 patients treated with either transdermal estradiol 0.05 mg/ day or oral conjugated estrogens 0.0625 mgjday for 18 months in a comparative study, only 1 transdermal estradiol-treated patient stopped therapy because of adverse events, vs 5 oral estrogen users ).…”