BLEEDING PATTERN AND CLIMACTERIC SYMPTOMS DURING DIFFERENT SEQUENTIALCOMBINED HRT REGIMENS IN CURRENT USE

Four sequential combined oestrogen and progestogen regimens were compa red in terms of bleeding pattern and relief of climacteric symptoms. T reatment was with either 2 mg 17 beta-oestradiol with 1 mg norethister one acetate [E(2) + NETA]; 2 mg oestradiol valerate with 75 mu g levon orgestrel [E(2)V + LNG]; 2 mg oestradiol valerate with 10 mg medroxypr ogesterone acetate [E(2)V + MPA]; or 1.5 mg 17 beta-oestradiol with 15 0 mu g desogestrel [E(2) + DG]. A placebo-controlled study lasting 12- 24 months was completed by 143 healthy early postmenopausal women. Ble eding lengths were not substantially different; in all regimens the ma jority of women were bleeding for 3-6 days. Bleeding onset showed diff erences when related to the 11th day of progestogen addition; in the r egimen with E(2)V + LNG, 21% of the women were bleeding before the 11t h day of progestogen addition 26% on, and 53% after that day. In the r egimen with E(2)V + MPA, 56% of the women were bleeding before the 11t h day, 28% on, and 17% after that day, whereas in the regimen with E(2 ) + DG, 15% of the women were bleeding before the 11th day, 5% on, and 80% after that day. All regimens reduced climacteric symptoms to the same extent. Breast tenderness occurred in all the regimens, except in the E(2) + DG. Conclusively, the differences between the responses to treatment were not conspicuous. However, our data indicate that one r egimen (E(2) + DG) resulted in optimal bleeding control, optimal effec t on climacteric symptoms, and no production of breast tenderness.