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