A comparative 2-year study of the effects of sequential regimens of 1 mg 17β-estradiol and trimegestone with a regimen containing estradiol valerate and norethisterone on the bleeding profile and endometrial safety in postmenopausal women

Abstract

Objective. To compare the bleeding profiles and endometrial protection of two sequential regimens of 17β-estradiol (17β-E₂) and trimegestone (TMG) with a sequential estradiol valerate (E₂V)/norethisterone (NET) regimen.

Study design. This was a randomized, double-blind, multicenter study conducted in eight countries in healthy, postmenopausal women with an intact uterus. A total of 1218 women were enrolled into the initial 1-year study (13 cycles), and subsequently 531 of these received treatment for a further year (26 cycles). Treatment regimens were 1 mg 17β-E₂ on days 1–14 and 1 mg 17β-E₂/0.125 mg TMG or 1 mg 17β-E₂/0.25 mg TMG on days 15–28, and 1 mg E₂V on days 1–16 and 1 mg E₂V/1 mg NET on days 17–28.

Results. Mean percentage of women reporting onset of withdrawal bleeding episodes during the week following discontinuation of progestogen was higher in the 1 mg 17β-E₂/0.25 mg TMG group than in the other two treatments, showing a more efficient progestogen effect on the endometrium and good predictability of bleeding onset with this treatment. The mean numbers and average lengths of bleeding episodes were similar in the three treatment groups. Overall, the bleeding profile was more favorable with 1 mg 17β-E2/0.25 mg TMG than with the lower-dose TMG preparation. Both of the TMG regimens demonstrated a good protective effect on endometrial proliferation, with the 0.25 mg TMG dose showing a lower incidence of proliferative endometrium.

Conclusion. The 1 mg 17β-E₂/0.25 mg TMG regimen showed an adequate protection of the endometrium, with an overall favorable bleeding profile.

• Trimegestone
• estradiol
• norethisterone
• sequential combined hormone replacement therapy
• menopause
• bleeding profile
• endometrial safety