Continuous combined conjugated equine estrogen—progestogen therapy: Effects of medroxyprogesterone acetate and norethindrone acetate on bleeding patterns and endometrial histologic diagnosis

Hillard, Tim; Siddle, N. C.; Whitehead, M. I.; Fraser, David I.; Pryse‐Davies, J.

doi:10.1016/s0002-9378(11)91614-7

Cited by 55 publications

(19 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…During the reproductive years, nearly 20% of women exhibit menorrhagia (excessive blood loss during menstruation) (7,8), and almost every woman during her lifetime experiences episodes of abnormal endometrial bleeding (6). The primary conditions that are associated with deranged priming of endometrium by the steroid hormones include aberrant follicular maturation, ovulation or development of corpus luteum (6,9,10), and administration of steroid hormones, including progestagens (9,(11)(12)(13). The underlying basis for dysfunctional uterine bleeding, a common gynecological disorder that affects women during the reproductive years, is also due to an inappropriate exposure of endometrium to steroid hormones.…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, dysfunctional uterine bleeding may occur during the secretory phase, due to, for example, an inadequate luteal phase (9). Bleeding which occurs as spotting or breakthrough-bleeding, or occasionally as heavy bleeding, may happen while the steroid hormones are being administered as a therapeutic measure or for contraception (9,(11)(12)(13). Despite the knowledge that steroid hormones are responsible for normal and abnormal endometrial bleeding, the identity of the local and specific endometrial factors which are implicated remain largely unrecognized.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Detection of ebaf, a novel human gene of the transforming growth factor beta superfamily association of gene expression with endometrial bleeding.

Kothapalli¹,

Buyuksal²,

Wu³

et al. 1997

J. Clin. Invest.

View full text Add to dashboard Cite

Human endometrium is unique since it is the only tissue in the body that bleeds at regular intervals. In addition, abnormal endometrial bleeding is one of the most common manifestations of gynecological diseases, and is a prime indication for hysterectomy. Here, we report on a novel human gene, endometrial bleeding associated factor ( ebaf ), whose strong expression in endometrium was associated with abnormal endometrial bleeding. In normal human endometrium, this gene was transiently expressed before and during menstrual bleeding. In situ hybridization showed that the mRNA of ebaf was expressed in the stroma without any singificant mRNA expression in the endometrial glands or endothelial cells. The predicted protein sequence of ebaf showed homology with and structural features of the members of TGF-␤ superfamily. Fluorescence in situ hybridization showed that the ebaf gene is located on human chromosome 1 at band q42.1. Thus, ebaf is a novel member of the TGF-␤ superfamily and an endometrial tissue factor whose expression is associated with normal menstrual and abnormal endometrial bleeding.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detection of ebaf, a novel human gene of the transforming growth factor beta superfamily association of gene expression with endometrial bleeding.

Kothapalli¹,

Buyuksal²,

Wu³

et al. 1997

J. Clin. Invest.

View full text Add to dashboard Cite

show abstract

“…Most authors have reported that 90-100% of women have endometrial atrophy (atrophy or insufficient tissue) as early in some cases as three months after treatment initiation. 7,23,24 Hyperplasia rates of less than 1% have been found after six months and one year. 25 Sturdee et al performed a multicentre study where 1196 women were treated with oral continuous combined HRT.…”

Section: Discussionmentioning

confidence: 99%

“…23,25,37 Bleeding after six months is generally uncommon. The Menopause Study Group looked at 1724 women on either unopposed conjugated equine oestrogens or with a combination of different doses of cyclical or continuous medroxyprogesterone acetate.…”

Section: Discussionmentioning

confidence: 99%

Bleeding profiles and effects on the endometrium for women using a novel combination of transdermal oestradiol and natural progesterone cream as part of a continuous combined hormone replacement regime

Vashisht

Wadsworth

Carey

et al. 2005

BJOG

View full text Add to dashboard Cite

Objective Many women are seeking alternatives to conventional forms of hormone replacement. This study evaluates the endometrial effects of natural progesterone cream used in conjunction with transdermal oestradiol. Design Open plan study conducted over 48 weeks.Setting Tertiary referral London teaching hospital.Population Women at least two years postmenopausal.Methods Women were recruited nationally. They applied 40 mg transdermal natural progesterone cream and 1 mg transdermal oestradiol daily. Main outcome measures Endometrial histology, assessed by pipelle endometrial biopsy, ultrasound assessment of endometrial thickness and bleeding diaries. Results Fifty-four women were recruited of which 41 completed the study. Mean age was 57.4 years. Thirtytwo percent of women had evidence of inadequate endometrial opposition (proliferative or hyperplastic) at the end of 48 weeks. At baseline, women had a mean endometrial thickness of 3.3 mm, which had significantly thickened to a mean of 5.3 mm by 24 weeks (P < 0.001). By 48 weeks, there was significantly greater increase in endometrial thickness from baseline in those women who displayed inadequate endometrial opposition, compared with those women who had adequate endometrial opposition (P ¼ 0.004). At 24 weeks, 48% of women had remained entirely amenorrhoeic. By the end of the study, 35% of women had been entirely amenorrhoeic and 50% had had either no bleeding or spotting alone. The number of bleeding episodes did not reduce with time. Conclusions The dose of natural progesterone cream in this study was insufficient to fully attenuate the mitogenic effect of oestrogen on the endometrium. We would not recommend this combination of hormones to be used by postmenopausal women.

show abstract

“…Other types of progestogens have been evaluated in observational studies of endometrial cancer, including medroxyprogesterone acetate, norethindrone, and norgestrel, with similar benefits [72]. Small-scale randomized controlled trials have shown adequate endometrial suppression in women taking estrogen with levonorgestrel, norgestimate, norethindrone, norethindrone acetate, or medroxyprogesterone acetate [72][73][74][75].…”

Section: Progestogen Typementioning

confidence: 99%

Indications for hormone therapy: the post-Women's Health Initiative era

Reed

Newton

LaCroix

2004

Endocrinology and Metabolism Clinics of North America

View full text Add to dashboard Cite

Continuous combined conjugated equine estrogen—progestogen therapy: Effects of medroxyprogesterone acetate and norethindrone acetate on bleeding patterns and endometrial histologic diagnosis

Cited by 55 publications

References 18 publications

Detection of ebaf, a novel human gene of the transforming growth factor beta superfamily association of gene expression with endometrial bleeding.

Detection of ebaf, a novel human gene of the transforming growth factor beta superfamily association of gene expression with endometrial bleeding.

Bleeding profiles and effects on the endometrium for women using a novel combination of transdermal oestradiol and natural progesterone cream as part of a continuous combined hormone replacement regime

Indications for hormone therapy: the post-Women's Health Initiative era

Contact Info

Product

Resources

About