Advertisement

Comparison of endometrial growth produced by unopposed conjugated estrogens or by micronized estradiol in postmenopausal women

      Abstract

      OBJECTIVES: When unopposed estrogen replacement treatment is used, what is the pattern of endometrial growth? Does endometrial growth differ for various dosages and formulations? STUDY DESIGN: A total of 87 postmenopausal women, median age 57 years (mean 56.7 ± 5.6 years, range 45 to 69 years), were studied in a prospective, randomized, open clinical trial lasting 24 weeks. The treatment arms consisted of micronized estradiol, 0.5 or 1.0 mg (Estrace, Bristol-Myers Squibb, Princeton, N.J.), and conjugated estrogens, 0.625 mg (Premarin, Wyeth-Ayerst, Philadelphia). Endometrial thickness was evaluated by vaginal probe ultrasonography at outset and after 6, 12, and 24 weeks of treatment. RESULTS: Endometrial growth was progressive over time; more than half the total 24-week growth occurred in the first 6 weeks. The mean weekly rate (±SD) of endometrial growth was similar for micronized estradiol, 1.0 mg, and conjugated estrogens, 0.625 mg (0.19 ± 0.15 mm for micronized estradiol, 1.0 mg, and 0.19 ± 0.14 mm for conjugated estrogens, 0.625 mg). These rates differed to a statistically significant degree (p < 0.05) from the growth rate produced by micronized estradiol, 0.5 mg (0.08 ± 0.16 mm). Both unscheduled and scheduled uterine bleeding was less likely among women using micronized estradiol, 0.5 mg, than among women using micronized estradiol, 1.0 mg, or conjugated estrogens, 0.625 mg. CONCLUSIONS: In a 24-week trial the therapeutically equivalent estrogen doses produced the same mean increment in endometrial thickness, but half-strength estradiol produced half as much endometrial growth. (Am J. Obstet Gynecol 1997;176:112-7.)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ettinger B
        • Selby J
        • Citron JT
        • VanGessel A
        • Ettinger VM
        • Hendrickson MR.
        Cyclic hormone replacement therapy using quarterly progestin.
        Obstet Gynecol. 1994; 83: 693-700
        • David A
        • Czernobilsky B
        • Weisglass L.
        Long-cyclic hormonal cycle therapy in postmenopausal women.
        in: The modern management of the menopause: a perspective for the 21st century. Proceeedings of the Seventh International Congress on the Menopause, Stockholm, Sweden, 1993. Parthenon, London1993: 463-470 (International congress, symposium, and seminar series No.: 8)
        • Hirvonen E
        • Salmi T
        • Puolakka J
        • Heikkinen J
        • Granfors E
        • Hulkko S
        • et al.
        Can progestin be limited to every third month only in postmenopausal women taking estrogen?.
        Maturitas. 1995; 21: 39-44
        • Lindgren R
        • Risberg B
        • Hammar M
        • Berg G.
        Transdermal hormonal replacement therapy with transdermal progestin every second month.
        Maturitas. 1995; 22: 25-30
        • Kemp JF
        • Fryer JA
        • Baber RJ.
        An alternative regimen of hormone replacement therapy to improve patient compliance.
        Aust N Z Obstet Gynaecol. 1989; 29: 66-69
        • Woodruff JD
        • Pickar JH.
        Incidence of endometrial hyperplasia in postmenopausal women taking conjugated estrogens (Premarin) with medroxyprogesterone acetate or conjugated estrogens alone: the Menopause Study Group.
        Am J Obstet Gynecol. 1994; 170 (Comment in Am J Obstet Gynecol 1995;172:1320): 1213-1223
        • Grady D
        • Gebretsadik T
        • Kerlikowske K
        • Ernster V
        • Petitti D.
        Hormone replacement therapy and endometrial cancer risk: a meta-analysis.
        Obstet Gynecol. 1995; 85: 304-313
        • Herrinton LJ
        • Weiss NS.
        Postmenopausal unopposed estrogens: characteristics of use in relation to the risk of endometrial carcinoma.
        Ann Epidemiol. 1993; 3: 308-318
        • Brinton LA
        • Hoover RN.
        Estrogen replacement therapy and endometrial cancer risk: unresolved issues: the Endometrial Cancer Collaborative Group.
        Obstet Gynecol. 1993; 81: 265-271
        • Jensen J
        • Christiansen C
        • Rødbro P
        Cigarette smoking, serum estrogens, and bone loss during hormone-replacement therapy early after menopause.
        N Engl J Med. 1985; 313: 973-975
        • Anderson KE
        • Kappas A
        • Conney AH
        • Bradlow HL
        • Fishman J.
        The influence of dietary protein and carbohydrate on the principal oxidative biotransformations of estradiol in normal subjects.
        J Clin Endocrinol Metab. 1984; 59: 103-107
        • Meuwissen JHJM
        • van Langen H
        • Moret E
        • Navarro-Morquecho I.
        Monitoring of oestrogen replacement therapy by vaginosonography of the endometrium.
        Maturitas. 1992; 15: 33-37
        • Clisham PR
        • Cedars MI
        • Greendale G
        • Fu YS
        • Gambone JC
        • Judd HL.
        Long-term transdermal estradiol therapy: effects on endometrial histology and bleeding patterns.
        Obstet Gynecol. 1992; 79: 196-201
        • Haenggi W
        • Birkhaeuser MH.
        A new peroral estrogen/progestin combination for postmenopausal hormonal substitution: an open multicentric field study.
        Maturitas. 1993; 16: 111-122
        • Lin MC
        • Gosink BB
        • Wolf SI
        • Feldesman MR
        • Stuenkel CA
        • Braly PS
        • et al.
        Endometrial thickness after menopause: effect of hormone replacement.
        Radiology. 1991; 180: 427-432