Endometrial response to a cyclic regimen of percutaneous 17β-estradiol and low-dose vaginal micronized progesterone in women with mild-to-moderate hypertension

Abstract

Endometrial response to natural estradiol and low-dose vaginal progesterone replacement therapy was evaluated in 20 postmenopausal women with chronic ,mild-to-moderate hypertension. A cyclic hormone replacementtherapy (HRT) regimen was used (21/28 days) with percutaneous estradiol (1.5 mg/day) and vaginal micronized progesterone (100 mg/day). Menopausal symptoms decreased and estradiol concentrations increasedsubstantially and remained in the physiological range throughout treatment. Serum gonadotropin concentrations decreased significantly (p < 0.001 ,Friedman's ANOVA). Bone mineral density increasedby 2.1% (p = 0.029) only at the lumbar spine. Endometrial thickness remained unchanged. Breakthrough bleeding or spotting occurred in 18% of cycles in the first 3 months of HRT ,30% in months 4-9and 22% in months 10-12. Withdrawal bleeding occurred in 40% of cycles in the first 3 months and decreased to 25% in months 10-12. At month 12 ,there were 11 women with amenorrhea due to endometrial atrophy.Nine women had active endometria (proliferative or secretory) and thus reported vaginal bleeding. No severe bleeding ,hyperplasia ,or carcinoma was found. Vaginal bleeding was tolerated ,and no subjectwithdrew from the study. Results suggest that this regimen confers endometrial protection and is well tolerated ,and can therefore safely be used for at least 1 year by postmenopausal women with hypertensionand menopausal symptoms.