Transdermal estradiol and oral or vaginal natural progesterone: bleeding patterns

Abstract

Transdermal estrogen replacement therapy combined with 100 mg of micronized NP administered per vagina from the 14th day to the 25th day of each 28-day cycle leads to good cycle control and provides excellent patient satisfaction without serious side-effects. This therapy could be a treatment of first choice in early postmenopausal patients.

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

“…Participants received continuous, transdermal estradiol (E2) (25 21 -50 5,6 lg/ day) which was sequentially combined with either different oral progestogens (medroxyprogesterone acetate (MPA), nomegestrol acetate (NOMAC), dydrogesterone (DYD), MP) 6 , MP applied orally or vaginally at different dosages (100 or 200 mg/day) 5 or oral MP 100 mg/day for 2 weeks every 6 months (extended cycle) 21 . In those studies with head-tohead comparisons, there were no significant group differences for endometrial thickness at baseline and after 12 cycles 5,6 . When comparing the baseline endometrial thickness with that at study closure, there was either no change (extended cycle regimen at oral MP 100 mg/day 21 , sequential regimen at vaginal MP 200 mg/day 5 ), or a significant increase 5,6 .…”

“…In those studies with head-tohead comparisons, there were no significant group differences for endometrial thickness at baseline and after 12 cycles 5,6 . When comparing the baseline endometrial thickness with that at study closure, there was either no change (extended cycle regimen at oral MP 100 mg/day 21 , sequential regimen at vaginal MP 200 mg/day 5 ), or a significant increase 5,6 . Another two small, non-controlled studies using either oral MP 200-300 mg/day for 10 days per month 16 or 100 mg/day for 23 days per month 10 reported no change 10 or an endometrial thickness of less than 2 mm after 1 year 16 .…”

“…In RCTs, vaginal MP was either compared at different dosages 5,28,34 or to intrauterine LNG 27 . The sample size ranged from 20 32,36 to 136 29 postmenopausal women, and treatment duration from 21 days 32 to 3 years 33 .…”

“…Endometrial thickness measured by TVUS was assessed in postmenopausal women in one 3-year, placebo-controlled, randomized, controlled trial (RCT) (n ¼ 167) 21 and two 1-year RCTs (n ¼ 100) with head-to-head comparisons 5,6 . Participants received continuous, transdermal estradiol (E2) (25 21 -50 5,6 lg/ day) which was sequentially combined with either different oral progestogens (medroxyprogesterone acetate (MPA), nomegestrol acetate (NOMAC), dydrogesterone (DYD), MP) 6 , MP applied orally or vaginally at different dosages (100 or 200 mg/day) 5 or oral MP 100 mg/day for 2 weeks every 6 months (extended cycle) 21 .…”

“…The method of endometrial thickness assessment was described by two authors only 5,6 using the maximal thickness of the endometrium in the longitudinal plane of the uterus.…”