Relief of Vasomotor Symptoms and Vaginal Atrophy With Lower Doses of Conjugated Equine Estrogens and Medroxyprogesterone Acetate

Utian, Wulf H.; Shoupe, Donna; Bachmann, Gloria; Pinkerton, Jo Ann V.; Pickar, James H.

doi:10.1097/00006254-200111000-00021

Cited by 52 publications

(87 citation statements)

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“…24 Studies of ET have typically demonstrated differences after approximately 8 to 12 weeks. [25][26][27][28][29][30][31] The Women's Health, Osteoporosis, Progestin, Estrogen trial, which tested CEE at 0.625, 0.45, and 0.3 mg/day, alone and with MPA 2.5, 1.5, and 1.5 mg/day, respectively, demonstrated efficacy for all regimens compared with placebo. 25 However, the rate of decline in vasomotor symptoms was slightly faster with the progestin-containing regimens.…”

Section: Vasomotor Symptomsmentioning

confidence: 99%

“…[25][26][27][28][29][30][31] The Women's Health, Osteoporosis, Progestin, Estrogen trial, which tested CEE at 0.625, 0.45, and 0.3 mg/day, alone and with MPA 2.5, 1.5, and 1.5 mg/day, respectively, demonstrated efficacy for all regimens compared with placebo. 25 However, the rate of decline in vasomotor symptoms was slightly faster with the progestin-containing regimens. Another study that tested 2 progestin doses in an estrogen-progestin combination (E 2 0.5/ NETA 0.1 mg/day and E 2 0.5/NETA 0.25 mg/ day) found a significant decrease in the frequency and severity of hot flashes for each active treatment versus placebo after 3 weeks ( Figure 1).…”

Section: Vasomotor Symptomsmentioning

confidence: 99%

“…Considerable evidence indicates that lower doses of HT effectively relieve vasomotor symptoms (Table 4). [22][23][24][25][26][27][28][29][30] A recent study of 425 women with at least 50 moderate-to-severe hot flashes per week found that low-dose transdermal estradiol (0.014 mg/day) was effective in reducing vasomotor symptoms compared with placebo. 22 Oral doses as low as 0.3 mg daily of esterified estrogens were also effective.…”

Section: Vasomotor Symptomsmentioning

confidence: 99%

“…Low-dose estrogen therapy has been shown to significantly reduce vaginal atrophy and its associated symptoms in clinical trials. 25,28,29,32 In general, studies have shown that low-dose estrogen formulations provide greater improvement in vaginal epithelium than placebo but less than that observed with conventional doses of estrogen. 32 In a recent trial of the impact of 2 low-dose formulations of E 2 (0.5 mg/ day with either 0.1 mg or 0.25 mg NETA) in a population of younger postmenopausal women who had a low baseline incidence of urogenital symptoms, both therapies resulted in a reduction in vaginal dryness scores and a statistically significant improvement in vaginal maturation and vaginal pH compared with placebo.…”

Section: Vulvovaginal Atrophymentioning

confidence: 99%

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Efficacy, Safety, and Tolerability of Low-Dose Hormone Therapy in Managing Menopausal Symptoms

Langer¹

2009

The Journal of the American Board of Family Medicine

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The primary indication for postmenopausal hormone therapy (HT) is to relieve the vasomotor symptoms (hot flashes, night sweats) and vaginal dryness and discomfort that often accompany the menopausal transition and beyond. These symptoms, which are attributed to the natural decline in estrogen during and after menopause, can be remedied with HT. The loss of bone mineral density (BMD) and associated skeletal fragility and increased risk of fracture are also effectively mitigated by HT in postmenopausal women.1-3 In women with a uterus, a progestin is used to oppose estrogen-stimulated endometrial proliferation and protect against endometrial cancer. The safety and tolerability of therapeutic agents must be considered in balance with their clinical efficacy. Reports from the Women's Health Initiative (WHI) trials raised concerns about venous thromboembolic events (VTEs), coronary heart disease (CHD), breast cancer, and stroke in women who were an average of 12 years postmenopause and received estrogen plus progestin (EPT) when compared with women who received placebo (Table 1).2,4 -10 The estrogen-alone (ET) arm in women without a uterus found increased risks of thromboembolic events and stroke with treatment but no increase in CHD or breast cancer (Table 2). 3,4,[11][12][13] Both trials found reduced risks for major fracture and colorectal cancer, the latter particularly in women randomized closer to menopause. 2,3However, given that the WHI study population may have been at greater risk for adverse events by virtue of age and years since menopause, the relevance of WHI data to the management of the typical symptomatic woman has been questioned. Consistent with the most commonly prescribed treatment options at the time the WHI trials were designed, HT doses of 0.625 mg conjugated equine estrogen (CEE) with or without 2.5 mg medroxyprogesterone acetate (MPA) were used. Publication of the initial results from the WHI EPT trial focused attention on the adoption of lower HT doses in clinical practice.14 Today, the use of lower starting doses for treatment of postmenopausal symptoms is increasingly recommended.14,15Currently, oral doses as low as 0.3 mg/day of CEE and 0.5 mg/day of 17␤-estradiol (E 2 ) are available to treat menopausal symptoms, and transdermal patches are available with estradiol doses as low as 0.014 mg/day. The purpose of this article is to describe what is known about the efficacy, safety, This article was externally peer reviewed.

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Section: Vasomotor Symptomsmentioning

confidence: 99%

Section: Vasomotor Symptomsmentioning

confidence: 99%

Section: Vasomotor Symptomsmentioning

confidence: 99%

Section: Vulvovaginal Atrophymentioning

confidence: 99%

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Efficacy, Safety, and Tolerability of Low-Dose Hormone Therapy in Managing Menopausal Symptoms

Langer¹

2009

The Journal of the American Board of Family Medicine

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“…The uncontested main indication for HRT remains the relief of post-menopausal symptoms, which brings a major improvement in quality of life [15][16][17][18]. No other therapy has proved to be more effective than HRT in this respect.…”

Section: Climacteric Syndromementioning

confidence: 99%

Is HRT still indicated for the primary prevention of osteoporosis?

Birkhäuser

2009

Gynecological Endocrinology

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Evaluation of Cardiovascular Event Rates With Hormone Therapy in Healthy, Early Postmenopausal Women

Løbo

2004

Arch Intern Med

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Relief of Vasomotor Symptoms and Vaginal Atrophy With Lower Doses of Conjugated Equine Estrogens and Medroxyprogesterone Acetate

Cited by 52 publications

References 0 publications

Efficacy, Safety, and Tolerability of Low-Dose Hormone Therapy in Managing Menopausal Symptoms

Efficacy, Safety, and Tolerability of Low-Dose Hormone Therapy in Managing Menopausal Symptoms

Is HRT still indicated for the primary prevention of osteoporosis?

Evaluation of Cardiovascular Event Rates With Hormone Therapy in Healthy, Early Postmenopausal Women

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