Transdermal Estradiol With Oral Progestin: Biological and Clinical Effects in Younger and Older Postmenopausal Women

Abstract

The purpose of this study was to compare the biochemical and clinical effects of transdermal estrogen replacement therapy (tERT) in younger and older postmenopausal women. We treated 15 younger (less than 60 y) and 13 older (greater than or equal to 60 y) healthy postmenopausal women (45-72 y) with four successive 8-week regimens of tERT at doses of 0 to 150 micrograms/day, combined with cyclic oral medroxyprogesterone acetate (MPA). In both age groups, there were similar (p = .0001) dose-responsive increases in plasma estrogen levels and decreases in LH and FSH levels, although LH values were lower in older women both before and after tERT (p less than .02). The addition of MPA further suppressed LH and, to a lesser extent, FSH in both younger and older women. The ratio of estrogenized to nonestrogenized vaginal cells increased with tERT (p less than .007) in both age groups, but significant symptomatic improvement of vaginal irritation was noted only at the highest tERT dose. Adverse effects unrelated to age included short-term nausea in 4/28 women, and skin irritation at the patch sites in 20/28 women. Vaginal bleeding was of shorter duration, but breast tenderness was more common in older women. Further studies of long-term tERT effects in elderly women are indicated.

Chronic disability trends in elderly United States populations: 1982–1994

“…Exogenous estrogens were used in 1985 by 3 million United States women to treat postmenopausal symptoms. By 1995, nearly 10 million United States women were taking estrogens, which may have benefit for such highly prevalent, disabling conditions as osteoporosis and cardiovascular disease (65)(66)(67). A recent study suggested that exogenous estrogens might delay the onset of Alzheimer's disease by 5-8 yearsand possibly reduce the prevalence of that highly disabling condition in females by 50%.…”

Predictors of breast discomfort among women initiating menopausal hormone therapy

“…The use of different HT preparations(11, 77, 78), the earlier assessment of breast discomfort (e.g. at 10 weeks after HT initiation (78)), older age of participants(77), and higher numbers of women who smoke in prior studies may explain the discrepancy in results of the current study compared to prior studies. Moreover, we found no evidence that new-onset breast discomfort was influenced by dietary alpha-tocopherol intake among postmenopausal women assigned to CEE or CEE + progestogen therapy.…”

“…Randomized controlled trials of HT regimens other than ours have implicated older age to be positively associated (77, 78) and smoking to be inversely associated (11) with risk of HT-associated breast discomfort. The use of different HT preparations(11, 77, 78), the earlier assessment of breast discomfort (e.g.…”

“…Randomized controlled trials of HT regimens other than ours have implicated older age to be positively associated (77, 78) and smoking to be inversely associated (11) with risk of HT-associated breast discomfort. The use of different HT preparations(11, 77, 78), the earlier assessment of breast discomfort (e.g. at 10 weeks after HT initiation (78)), older age of participants(77), and higher numbers of women who smoke in prior studies may explain the discrepancy in results of the current study compared to prior studies.…”

How to evaluate the risk-benefit ratio of the low-dose hormone replacement therapy?

“…Bellantoni et al [8] observed a higher incidence of breast tenderness with higher doses of estrogen, particularly in women aged >60 years compared to women aged <60 years. In a trial that compared two doses of 17␤-estradiol delivered transdermally (20 g/day versus 40 g/day), 6% of the women in the 20 g group reported breast pain compared with 14% of those who received the higher dose [9].…”