F147 Control of menopausal symptoms in women denied oestrogen using unopposed megestrol acetate

F147 CONTROL OF MENOPAUSAL SYMPTOMS DENIED OESTROGEN USING UNOPPOSED ACETATE

PI48 IN WOMEN

USEOF MICRONISED PROGESTERONE IN WOMEN INFER ESTROGEN REPLACEMENT T~E~PY: ORAL VS

~EGESTR~L

VAGINAL

ROUTE

K Ekevail, J Barnes, D M Hart,

P R Fiweroa-Casns,

MenopauseClinic, Stobhili NHS Trust, Glasgow G21 3UW, Scotland,UK

HospitalSdnz-Pefia,Rosario,Argentina

Few absolutecontra-indicationsto oestrogen-conlai~inghormone replacementtherapy remain. However, many womenwith past historiesof oestrogendependentturnoutsor thrombo-embolism are deniedhormonereplacement. Such womenmay be treatedwith progestogens without the potential “risks” of oestrogentherapy. Some women in these categoriesdecline oestrogeneven after reassur~ceby their medicaladvisers. This Study assesses the symptom relief provided by the progestogenMegestrol acetate (Megace). Twenty eightwomenwith a pasthistory of breastcancer, endometrial cancer, thrombo-embolic phenomena or severe endometriosiswere treated with megestrolacetate40 mg daily continuously,increasingto 80 mg daily continuouslyif requiredfor symptomcontrol, for one year, completinga validated symptom scorechart (the GreeneCtimactericScale)at 0, 3, 6, and 12months. Analysis showedsignificant reduction(p < 0.001) in vasomotor symptomsafter three months, maintainedfor the duration of treatment. Anxiety and depressionscoresdecreasedsteadilyover the year but did not achieve significance. Adverse effects, principally weight gain, fluid retention symptomsand vaginal bleeding were common (57.1%) and 10 women discontinued treatment(35.7%). Womenwith breastcarcinomareportedfewer adverseevents(15.4%).

E Delgado, C Vieder, D Rodriguez-

Vidal

OBJECTIVE: To comparethe effects of MicronisedProgesterone (Ml?) administeredby oral or vaginal route on progesterone(P) plasmalevels and on the endometriumin womenunder estrogen replacementtherapy (ETR). METHODOLOGY: Sixteen women with I to 5 years of postmenopause received 0.75 mg daily of estradiolpercutaneously during 2 cyclesof 30 days with one week free-intervalbetweenthem. Fromday 17to 30 of first cycle200 mg of MP wereadministered to 16 women:8 receivedthe drug orally and8 intravag~naily~ in the secondcycle the route of administration wasinverted. On days 16 and30 of eachcycle P wasmeasured by RIA. Before ER?‘ and on day 30 of the secondcycle, vaginal ultrasoundandendometrialbiopsywereperformed. RESULTS:MeanplasmaP(ng/ml)on day30 were:oral route: 4.3 t: 3,8(0.4-10.4);vaginalroute: 2.6 2 2.2 (0.3-7.3)fp<0.05). The mean increaseof plasmaP comparingday 30 valueswith day 16 values was:oral route: 3.8 4 3.2: vaginalroute: 2.0 52 (~~0.05).Whenthe sameincreasefor eachpatientwascompared.significantdifferences (p
P149

Pl48 (cord)

CARDIOVASCULAR RISK FACTORS, BLEEDING PATTERNS AND ENDOMETRIAL HISTOLOGY TN POSTMENOPAUSAL WOMEN TAKING SEQUENTIAL

Basalendometrialbiopsiesshowedatrophicendometrium in 9 cases, proliferative in 4 and no tissuein 2; at the end of the study 13 biopsiesshoweda secretoryendometrium;in 3 cases-2 receiving MP orally andI intravaginally-showedno tissue. CONCLUSIONS: These results indicate that, although orally administered MP inducedplasmaP levelssignificantlyh&hersthan intravaginally administrationof MP, the effect of both routes of admjnis~ationon the endometrinmappearsto be similaraccording to ultrasoundandhistologicalfindings.

89

COMBINED ESTRADIOL AND DYDROGESTERONE (FEMOSTON), MM

RESULTS

FROM A ONE-YEAR

STUDY

Gelfund A Ferenczy,

JewishGeneralHospital,5750 C&e desNeiges,Montreal, Quebec H3S 1Y9, Canada. To assess the effectsof Femoston(2 mg micronizedestradioldaily, sequentiallycombinedin onetablet with 10 mg dydro8esterone for 14daysper 28day cycle) on serumlipid profiles,bleedingpatterns and endometrialhistology, I88 postmenopausal women were enteredinto a one-yearmulti-centredstudy. After I2 months,one notedan increaseof 20% in HDL while meanserumlevelsof total cholesterolandLDL weredecreased 5% and20%,respectively. TrigIycerideswere also increased. Blood pressureand heart rate remainedunchanged. In 97.2% of the women, the endometrialhistology showedan adequate progestational response (secretory or atrophic endometrium). One simple hyperplasiawas diagnosed. Cyclic bleedingoccurred in 85% of all cycles, the day of onset was regularly on day 13 or 14 of the combinedperiod and the mean duratjonwasapproxjmate~y 5 dayswith minimalbleeding. Only 2 womendiscontinued therapybecause of bleedingproblems. In conclusion,the useof Femostonshowedvery favourablelipid metabolism resultsaswell asendometrialsafety.