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To Bleed or Not To Bleed? That's the Hormone Replacement Therapy Question

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WebMD Health News

April 3, 2000 (New York) -- If you are considering hormone replacement therapy (HRT), consider this: If you and your doctor can find a therapy that eliminates monthly and irregular bleeding, it may be easier for you to stick with the program. And if you are already on HRT and have spotting or monthly bleeding, you can ask your doctor about other options that are available.

A study in the February issue of the American Journal of Obstetrics and Gynecology shows that postmenopausal women who took a daily dose of the female hormone estrogen combined with a relatively small amount of progestin were more likely to still be taking their medication after a year than women who were taking estrogen each day but only taking progestin two weeks of each month. Progestin is a substance that mimics the hormone progesterone.

"We know from other research studies that the benefits of HRT, as far as contributing to cardiovascular health and prevention of osteoporosis, aren't really apparent until women take HRT for a number of years. Therefore, it is important to identify therapies that women find acceptable for sustained use," says study author Deirdre A. Hill, PhD, a researcher at the Division of Cancer Epidemiology and Genetics of the National Institutes of Health in Bethesda, Md. Hill conducted the research while at the University of Washington in Seattle.

Ninety women who participated in the study were initially treated with daily combined estrogen and progestin therapy, and nearly 115 received daily estrogen plus progestin two weeks of the month. For example, all patients received 0.625 mg of estrogen daily. Women taking both medications daily also received 2.5 mg of progestin each day. Women in the other group usually took 5 mg or 10 mg of progestin a day for two weeks of each month.

After a year of therapy, the investigators found that nearly 70% of the women taking the daily, continuous combination therapy -- that is, estrogen and progestin daily -- were still taking their medication. Less than 55% of the other group were still taking their medication, and they were also twice as likely to switch medications.

"Menopausal symptoms decreased to a comparable degree on either therapy," says Hill. "What differentiated the two therapies was that there was less monthly bleeding with the [daily estrogen and progestin therapy], and, therefore, women were more likely to continue to take it."

After a year, nearly 60% of the women taking estrogen daily plus two weeks of progestin each month reported vaginal bleeding. Less than 10% of women taking both medications daily had bleeding. Irregular bleeding was similar for the two groups.

Both groups of women had a rather high rate of quitting treatment altogether, however. The most frequently cited reason for quitting was beginning a monthly period again or irregular bleeding, although nervousness, anxiety, irritability, water retention, and weight gain were other reasons.

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