A low-dose start in hormone replacement therapy provides a beneficial bleeding profile and few side-effects: randomized comparison with a conventional-dose regimen

Background: Estrogen therapy in younger postmenopausal women is associated with a decisive reduction in morbidity and mortality, but estrogen use in this population is low because of risk of side effects. Weekly intermittent therapy is a more patient friendly approach with reduced pill burden increasing compliance and adherence as well as reducing side effects. Therefore, authors wanted to study the effect of weekly intermittent fixed dose estrogen and progesterone (ultra-low dose) supplements in hysterectomised surgically menopaused women.Methods: The present study was prospective and retrospective study. For retrospective study authors records of 100 hysterectomised women up to 45years of age with severe post-menopausal symptoms treated in authors Medicine Department of Hospital with once weekly MALA-D tablets were studied. For prospective study, all consecutive hysterectomised patients with severe post-menopausal symptoms attending medicine OPD were given once weekly MALA-D which contains ethinylestradiol 0.03mg and levonorgestrel 0.15mg tablets and followed up monthly with outcomes measured by Modified Kuppermann Index, visual analogue scale, and women’s health questionnaires.Results: Present retrospective study showed moderate degree of postmenopausal symptoms as indicated by Modified Kuppermann index of 19.57. Prospective study showed significant improvement in postmenopausal symptoms with weekly intermittent hormone replacement therapy as indicated by outcomes measured by Modified Kupperman index and Visual analogue scale. Women’s health questionnaire also showed statistically significant improvement in 6 out of 8 dimensions.Conclusions: Authors concluded that weekly estrogen progesterone hormone replacement therapy with mala-D tablet (ultra-low dose therapy) was 100% effective in relieving vasomotor symptoms and it is very effective in improving psychosomatic symptoms, urinary symptoms and quality of life with no obvious side effects and greater adherence.

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Low dose hormone replacement therapy improves endothellum-dependent vasodilator responsiveness comparable to conventional dose in postmenopausal women

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)81128-7 ◽

2002 ◽

Vol 39 ◽

pp. 252

Author(s):

Kwang K. Koh ◽

Hyung S. Kim ◽

In S. Choi ◽

Eak K. Shin

Keyword(s):

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Postmenopausal Women ◽

Low Dose ◽

Hormone Replacement ◽

Conventional Dose

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Faculty Opinions recommendation of Effects of low-dose continuous combined hormone replacement therapy on glucose homeostasis and markers of cardiovascular risk in women with type 2 diabetes.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1058971.510928 ◽

2007 ◽

Author(s):

Henry Burger

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Glucose Homeostasis ◽

Low Dose ◽

Hormone Replacement

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Long-Term Continuous Combined Hormone Replacement Therapy in the Prevention of Postmenopausal Bone Loss: A Comparison of High- and Low-Dose Estrogen-Progestin Regimens

Osteoporosis International ◽

10.1007/s001980070031 ◽

2000 ◽

Vol 11 (11) ◽

pp. 929-937 ◽

Cited By ~ 30

Author(s):

J. Heikkinen ◽

R. Vaheri ◽

P. Kainulainen ◽

U. Timonen

Keyword(s):

Hormone Replacement Therapy ◽

Bone Loss ◽

Replacement Therapy ◽

Low Dose ◽

Hormone Replacement ◽

Postmenopausal Bone Loss

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Efficacy and tolerability of continuous combined hormone replacement therapy in early postmenopausal women

Menopause International: The Integrated Journal of Postreproductive Health ◽

10.1258/175404507781605596 ◽

2007 ◽

Vol 13 (3) ◽

pp. 124-131 ◽

Cited By ~ 6

Author(s):

L A Mattsson ◽

S Skouby ◽

M Rees ◽

J Heikkinen ◽

M Kudela ◽

...

Keyword(s):

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Postmenopausal Women ◽

Dose Regimen ◽

Hormone Replacement ◽

Secondary Outcome ◽

Estradiol Valerate ◽

Hot Flushes ◽

Double Blind ◽

Early Postmenopausal Women

Objective. Continuous combined hormone replacement therapy (ccHRT) based on estradiol valerate (E2V) and medroxyprogesterone acetate (MPA) is effective for relief of menopausal symptoms three years or more after the menopause. This study was undertaken to examine the efficacy and tolerability of ccHRT in early postmenopausal women (last menstrual period 1.3 years before study entry). Study design. This was a 52-week, randomized, double-blind, multinational study of ccHRT comprising three different dose combinations of E2V/MPA in 459 early postmenopausal non-hysterectomized women experiencing 30 or more moderate to severe hot flushes a week and/or vasomotor symptoms requiring treatment. Main outcomes measures. The primary endpoint was change in frequency and severity of moderate to severe hot flushes at 12 weeks. Secondary outcome measures included number of bleeding days and evaluation of tolerability. Results. The frequency of hot flushes was reduced by ≥70% after one month ( P<0.001 for all doses at week 2 onwards), with little evidence of statistically different dose effects. Severity of flushing was also attenuated by ccHRT. Mean number of bleeding days fell to <1 per 28-day cycle at 52 weeks. Rates of amenorrhoea approached 80–90% at the end of the study, but were significantly lower at several time points with the highest-dose regimen (2 mg E2V + 5 mg MPA) than with the lower-dose options (1 mg E2V + 2.5 mg MPA and 1 mg E2V + 5 mg MPA; P<0.05). Adverse events declined in frequency over time with all regimens but throughout the study were more numerous with the highest-dose regimen than with lower doses ( P= 0.0002). Conclusions. Continuous combined HRT was effective for the relief of climacteric symptoms in early postmenopausal women and was well tolerated.

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