When your doctor recommends hormone replacement
therapy (HRT) after menopause,
do visions of menses forever appear? How much bleeding
should you expect? There are two basic dose frequencies
-- sequential estrogen followed by progesterone and
continuous estrogen and progestin (synthetic progesterone).
With the sequential regimen there is almost always
some menstrual bleeding or spotting just like with
birth control pills. The continuous regimen is much
better however, with many women having no bleeding
at all.
In a recent article, Nand et al: Bleeding pattern
and endometrial changes during continuous combined
hormone replacement therapy. Obstet Gynecol 1998;91:678-84,
investigated estrone 1.25 mg (Ogen®) with 3 different
doses of medroxyprogesterone acetate (Provera®)
2.5 mg, 5.0 mg and 10mg. They recorded how much bleeding
568 women had over 2 years on the different regimens.
Interestingly, the investigators didn't find a significant
difference between the three different progestin doses
as to a lower incidence of bleeding on the higher
doses. At the end of 3 months of therapy 58% of women
were amenorrheic while 42% still had some bleeding.
At 6 months, 75-80% of women had no vaginal bleeding
at all. By 24 months, 90-94% of women were amenorrheic.
Almost 10% of women had bleeding no matter what dose
of progestin they were taking.
The study also tells us that the average number of
days of any bleeding on these hormonal regimens started
out from 6-9 days per month at the beginning of therapy
and declined to about 3 days of bleeding per month
after 2 years. There were no cases of endometrial
cancer or hyperplasia that occurred during the study
period.
The lessons to learn from this are:
even though many women don't have bleeding on this
continuous regimen, some do no matter how long they
take the medication.
raising the progestin dose is unlikley to lessen the
bleeding for most women who are having it
women should expect bleeding problems for the 1st
6-9 months on this regimen
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