Magazine article Drug Topics

Progestin Found Vital in Hormone Replacement Therapy

Magazine article Drug Topics

Progestin Found Vital in Hormone Replacement Therapy

Article excerpt

The use of conjugated equine estrogen (CEE) alone for hormone replacement therapy in postmenopausal women results in a higher incidence of endometrial hyperplasia than does CEE plus continuous or cyclic medroxyprogesterone acetate (MPA), or micronized progesterone. This was the finding of a study recently published in the Journal of the American Medical Association (JAMA). Furthermore, the results indicate that the progestin regimens used in the study provide longterm endometrial protection for postmenopausal women with a uterus.

These conclusions are based on the results of a histologic evaluation of the endometriums of women who were enrolled in the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The PEPI trial was a multicenter three-year study that evaluated the effects of estrogen with or without a progestin on risk factors for heart disease-high-density lipoprotein cholesterol, fibrinogen, insulin, and blood pressure-in 875 postmenopausal women. Of the 875 women enrolled in the PEPI trial, 596 had a uterus and were eligible for the histologic evaluation of their endometriums.

The results, as described in the JAMA article, pose serious concerns about the safety of long-term hormonal replacement therapy with only conjugated estrogens.

The investigators concluded, "Physicians who provide estrogen replacement therapy for postmenopausal women with a uterus should give serious consideration to the addition of a progestin. CEE-only therapy can be considered, but follow-up should include annual endometrial assessment with cessation of this regimen following the diagnosis of endometrial hyperplasia." The investigators further suggested that endometrial hyperplasia in postmenopausal women who are receiving CEE alone can be reverted to normal if progestins are prescribed for a prolonged period of time.

This study, according to Doyle Cummings, associate professor, Department of Family Practice at the East Carolina University School of Medicine, further substantiated the importance of progestins in hormone replacement therapy. More specifically, this portion of the PEPI trial revealed that the difference in the risk of developing endometrial hyperplasia between those women receiving CEE-only therapy and those receiving placebo is significant-the risk being much higher in the CEEonly group. …

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