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Hormone Replacement Patch Effective in Postmenopausal Women


WebMD Health News

Nov. 17, 1999 (Atlanta) -- The use of a combination skin patch -- delivering the sex hormones estrogen and progestin together -- is more effective than the use of an estrogen-only patch in preventing well-recognized complications from estrogen-only hormone replacement therapy (HRT) in postmenopausal women, according to a study in a recent issue of Obstetrics and Gynecology.

The study was done to test the effectiveness of CombiPatch, the first estrogen-progestin patch available. The CombiPatch is worn continuously on the abdomen and replaced twice weekly.

Doctors have known for some time that the risk of endometrial cancer -- cancer of the lining of the uterus (endometrium) -- is increased with use of estrogen alone for HRT in women who have a uterus. The addition of progestin -- a synthetic form of the natural sex hormone progesterone -- to estrogen for HRT reduces that risk.

The CombiPatch offers an alternative to the use of estrogen patches together with progestin pills, or the use of both hormones in pill form.

"For the majority of patients, it's a matter of preference, but there are considerations based on exact menopausal symptoms and based on a patient's background," Wulf Utian, MD, PhD, tells WebMD. Utian is executive director of the North American Menopause Society and was contacted for commentary on the study.

Women's cholesterol and triglyceride levels will be affected differently depending on the form of estrogen-progestin administration. This has long-term health implications for a woman, Utian says, depending on whether her HRT has been prescribed primarily to treat menopausal symptoms, such as hot flashes, or to provide protection against osteoarthritis and/or heart disease.

"This patch just adds to the treatment options we already have," says Utian, chair of reproductive biology at Case Western Reserve University. "There's so much direct-to-consumer advertising -- but the latest is not always the greatest. There's a great advantage to having a lot of options so we can really individualize. I don't have a single preference for treatment."

The one-year study compared the CombiPatch and the estrogen-only patch in 625 women ages 40-70. It found cases of endometrial thickening (a sign of increased risk of endometrial cancer) in 38% of the estrogen-only group -- compared to no more than 1.1% in the CombiPatch group, which included three different dosage strengths of progestin.

The study also found that patients given the combination patch experienced fewer episodes of bleeding and hot flashes overall than the estrogen-only group.

"In most cases, bleeding will run its course with hormone replacement over time, and bleeding can depend on how long [menopause has been ongoing before] therapy begins," says William Andrews, MD, professor emeritus of obstetrics and gynecology at Eastern Virginia Medical School in Norfolk. "My impression has been that in the end it is the same with either the patch or the pills."

The study was funded in part by Rhône-Poulenc Rorer.

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