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Evaluation of mastodynia in postmenopausal women taking hormone therapy
International Journal of Gynecology and Obstetrics (2005) 89, 158 — 159
www.elsevier.com/locate/ijgo
BRIEF COMMUNICATION
Evaluation of mastodynia in postmenopausal women taking hormone therapy S. Carranza-LiraT, M.P. Gardun ˜o-Herna ´ndez, D.A. Caisapanta, H. Aparicio Gynecologic Endocrinology Department, Hospital de Ginecologı´a y Obstetricia bLuis Castelazo Ayala,Q Instituto Mexicano del Seguro Social, Me´xico DF, Mexico Received 9 September 2004; received in revised form 16 November 2004; accepted 16 November 2004
KEYWORDS Mastodynia; Estrogens; Progestogens; Conjugated equine estrogens; Medroxyprogesterone; Chlormadinone
Hormone therapy (HT) is associated with mastodynia, which is present in up to 77% of menopausal and postmenopausal women taking continuous conjugated equine estrogens plus medroxyprogesterone (CEE+MPA) [1], and is also associated with higher breast density [2]. One explanation is that breast cell proliferation increases up to 40% or 50% in women taking hormone therapy [3]. Chlormadinone is a progestogen related to progesterone
T Corresponding author. Puente de piedra 150-422 Torre I, Col. Toriello Guerra C.P. 14050 Me ´xico D.F., Mexico. Tel./fax: +52 55 55284657. E-mail address: [email protected] (S. Carranza-Lira).
compounds such as MPA and ciproterone, both of which are widely used in Mexico. It has antiproliferative effects, however, which were demonstrated in a study that compared chlormadinone with progesterone and MPA, as the 3 progestins were associated sequentially with a continuous estrogen treatment [4].
Table 1 Baseline and final mastodynia intensity as indicated on a visual analog scale according to treatment group Mastodynia intensity
Group 1a (n=14)
Group 2b (n=18)
Group 3c (n=15)
Baseline Final
0.7F1.1 1.7F2.4f,g,h
0.8F1.0d 2.6F2.6d,h
0.3F0.89e 1.3F1.9e,g
a Group 1 received conjugated equine estrogens, 0.625 mg/ day. b Group 2 received conjugated equine estrogens, 0.625 mg/ day plus medroxyprogesterone, 2.5 mg/day. c Group 3 received conjugated equine estrogens, 0.625 mg/ day plus chlormadinone, 1 mg/day. d Pb0.03. e Pb0.005. f Pb0.04. g Pb0.06. h Pb0.06.
0020-7292/$ - see front matter D 2005 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2004.11.034
Evaluation of mastodynia The objective of this study was to analyze the changes in mastodynia intensity in postmenopausal women who received different types of HT. Forty-seven women who were older than 40 years, clinically and hormonally postmenopausal, and without previous mammary disease were studied. Sample size calculation was 12 patients per group. Three groups were formed prospectively. Group 1, which included women who had undergone hysterectomy, was assigned CEE, 0.625 mg/day (n=14); group 2 was assigned CEE, 0.625 mg/day plus MPA, 2.5 mg/day (n=18); and group 3 was assigned CEE, 0.625 mg/day plus chlormadinone, 1 mg/day. (n=15). Assignment in groups 2 and 3 was randomly done. Mastodynia intensity was evaluated at baseline and 3 months after the beginning of HT. The participants were asked to indicate their mastodynia intensity on a visual analog scale. This scale is a 10-cm line drawn on a sheet of paper where 0 is pain absence and 10 is the maximum intensity of pain the women can experience. Statistical analysis was done using the t-test for independent samples, the v 2 test, and the Pearson v 2 test. There were no differences between the women in age or in anthropometric variables. Mastodynia intensity was significantly greater in group 2 compared with group 1 ( Pb0.04), and there was a trend for mastodynia intensity to be greater in group 1 compared with group 3 ( Pb0.06). No differences in mastodynia intensity were found between the 2 progestin groups. Between baseline and final values in each group there was a trend toward greater final intensity values for mastodynia in group 1 ( Pb0.06), and this change was statistically significant in groups 2 and 3 ( Pb0.03 and Pb0.005, respectively) (Table 1). The percentage by which mastodynia intensity increased is shown in Table 2.
159 Table 2 Changes in mastodynia intensity in 3 groups of postmenopausal women according to treatmenta Group
Decrease
No change
Increase
1 2 3
1 (7) 1 (6) 0 (0)
8 (57) 7 (39) 10 (67)
5 (36) 10 (55) 5 (33)
Group 1 received conjugated equine estrogens, 0.625 mg/ day (n=14). Group 2 received conjugated equine estrogens, 0.625 mg/ day plus medroxyprogesterone, 2.5 mg/day (n=18). Group 3 received conjugated equine estrogens, 0.625 mg/ day plus chlormadinone, 1 mg/day (n=15). a Values are given as number (percentage).
The 2 progestins groups had a similar increase in mastodynia intensity. The percentage of women who had increase in mastodynia was greater in the group with CEE+MPA than in the other 2 groups. The lack of a placebo group and the manual randomization for the CEE group may limit the conclusions of this study.
References [1] Jackson VP, San Martin JA, Secrest RJ, McNabb M, CarranzaLira S, Figueroa-Casas P, et al. Comparison of the effect of raloxifene and continuous-combined hormone therapy on mammographic breast density and breast tenderness in postmenopausal women. Am J Obstet Gynecol 2003;188: 389 – 94. [2] Bulbul NH, Ozden S, Dayicioglu V. Effects of hormone replacement therapy on mammographic findings. Arch Gynecol Obstet 2003;268:5 – 8. [3] Isaksson E, von Schoultz E, Odlinf V, Soderqvist G, Csemiczky G, Calstrom K, et al. Effect of oral contraceptives on breast epithelial proliferation. Breast Cancer Res Treat 2001;65: 163 – 9. [4] Seeger H, Wallwiener D, Mueck AO. The effect of progesterone and synthetic progestins on serum and estradiolstimulated proliferation of human breast cancer cells. Horm Metab Res 2003;35:76 – 80.
www.elsevier.com/locate/ijgo
BRIEF COMMUNICATION
Evaluation of mastodynia in postmenopausal women taking hormone therapy S. Carranza-LiraT, M.P. Gardun ˜o-Herna ´ndez, D.A. Caisapanta, H. Aparicio Gynecologic Endocrinology Department, Hospital de Ginecologı´a y Obstetricia bLuis Castelazo Ayala,Q Instituto Mexicano del Seguro Social, Me´xico DF, Mexico Received 9 September 2004; received in revised form 16 November 2004; accepted 16 November 2004
KEYWORDS Mastodynia; Estrogens; Progestogens; Conjugated equine estrogens; Medroxyprogesterone; Chlormadinone
Hormone therapy (HT) is associated with mastodynia, which is present in up to 77% of menopausal and postmenopausal women taking continuous conjugated equine estrogens plus medroxyprogesterone (CEE+MPA) [1], and is also associated with higher breast density [2]. One explanation is that breast cell proliferation increases up to 40% or 50% in women taking hormone therapy [3]. Chlormadinone is a progestogen related to progesterone
T Corresponding author. Puente de piedra 150-422 Torre I, Col. Toriello Guerra C.P. 14050 Me ´xico D.F., Mexico. Tel./fax: +52 55 55284657. E-mail address: [email protected] (S. Carranza-Lira).
compounds such as MPA and ciproterone, both of which are widely used in Mexico. It has antiproliferative effects, however, which were demonstrated in a study that compared chlormadinone with progesterone and MPA, as the 3 progestins were associated sequentially with a continuous estrogen treatment [4].
Table 1 Baseline and final mastodynia intensity as indicated on a visual analog scale according to treatment group Mastodynia intensity
Group 1a (n=14)
Group 2b (n=18)
Group 3c (n=15)
Baseline Final
0.7F1.1 1.7F2.4f,g,h
0.8F1.0d 2.6F2.6d,h
0.3F0.89e 1.3F1.9e,g
a Group 1 received conjugated equine estrogens, 0.625 mg/ day. b Group 2 received conjugated equine estrogens, 0.625 mg/ day plus medroxyprogesterone, 2.5 mg/day. c Group 3 received conjugated equine estrogens, 0.625 mg/ day plus chlormadinone, 1 mg/day. d Pb0.03. e Pb0.005. f Pb0.04. g Pb0.06. h Pb0.06.
0020-7292/$ - see front matter D 2005 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2004.11.034
Evaluation of mastodynia The objective of this study was to analyze the changes in mastodynia intensity in postmenopausal women who received different types of HT. Forty-seven women who were older than 40 years, clinically and hormonally postmenopausal, and without previous mammary disease were studied. Sample size calculation was 12 patients per group. Three groups were formed prospectively. Group 1, which included women who had undergone hysterectomy, was assigned CEE, 0.625 mg/day (n=14); group 2 was assigned CEE, 0.625 mg/day plus MPA, 2.5 mg/day (n=18); and group 3 was assigned CEE, 0.625 mg/day plus chlormadinone, 1 mg/day. (n=15). Assignment in groups 2 and 3 was randomly done. Mastodynia intensity was evaluated at baseline and 3 months after the beginning of HT. The participants were asked to indicate their mastodynia intensity on a visual analog scale. This scale is a 10-cm line drawn on a sheet of paper where 0 is pain absence and 10 is the maximum intensity of pain the women can experience. Statistical analysis was done using the t-test for independent samples, the v 2 test, and the Pearson v 2 test. There were no differences between the women in age or in anthropometric variables. Mastodynia intensity was significantly greater in group 2 compared with group 1 ( Pb0.04), and there was a trend for mastodynia intensity to be greater in group 1 compared with group 3 ( Pb0.06). No differences in mastodynia intensity were found between the 2 progestin groups. Between baseline and final values in each group there was a trend toward greater final intensity values for mastodynia in group 1 ( Pb0.06), and this change was statistically significant in groups 2 and 3 ( Pb0.03 and Pb0.005, respectively) (Table 1). The percentage by which mastodynia intensity increased is shown in Table 2.
159 Table 2 Changes in mastodynia intensity in 3 groups of postmenopausal women according to treatmenta Group
Decrease
No change
Increase
1 2 3
1 (7) 1 (6) 0 (0)
8 (57) 7 (39) 10 (67)
5 (36) 10 (55) 5 (33)
Group 1 received conjugated equine estrogens, 0.625 mg/ day (n=14). Group 2 received conjugated equine estrogens, 0.625 mg/ day plus medroxyprogesterone, 2.5 mg/day (n=18). Group 3 received conjugated equine estrogens, 0.625 mg/ day plus chlormadinone, 1 mg/day (n=15). a Values are given as number (percentage).
The 2 progestins groups had a similar increase in mastodynia intensity. The percentage of women who had increase in mastodynia was greater in the group with CEE+MPA than in the other 2 groups. The lack of a placebo group and the manual randomization for the CEE group may limit the conclusions of this study.
References [1] Jackson VP, San Martin JA, Secrest RJ, McNabb M, CarranzaLira S, Figueroa-Casas P, et al. Comparison of the effect of raloxifene and continuous-combined hormone therapy on mammographic breast density and breast tenderness in postmenopausal women. Am J Obstet Gynecol 2003;188: 389 – 94. [2] Bulbul NH, Ozden S, Dayicioglu V. Effects of hormone replacement therapy on mammographic findings. Arch Gynecol Obstet 2003;268:5 – 8. [3] Isaksson E, von Schoultz E, Odlinf V, Soderqvist G, Csemiczky G, Calstrom K, et al. Effect of oral contraceptives on breast epithelial proliferation. Breast Cancer Res Treat 2001;65: 163 – 9. [4] Seeger H, Wallwiener D, Mueck AO. The effect of progesterone and synthetic progestins on serum and estradiolstimulated proliferation of human breast cancer cells. Horm Metab Res 2003;35:76 – 80.