TRANSDERMAL ESTROGEN WITH A LEVONORGESTREL-RELEASING INTRAUTERINE-DEVICE FOR CLIMACTERIC COMPLAINTS - CLINICAL AND ENDOMETRIAL RESPONSES

OBJECTIVE: Our purpose was to study the effects of intrauterine releas e of a daily dose of 20 mu g levonorgestrel by an intrauterine device on climacteric symptoms, bleeding pattern, and endometrial histologic features in postmenopausal women receiving transdermal estrogen replac ement therapy. STUDY DESIGN: Forty parous postmenopausal women were ra ndomly allocated into two groups for 1 year: 20 women receiving a cont inuous transdermal daily dose of 50 mu g of estradiol had a levonorges trel-releasing intrauterine contraceptive device inserted, and the con trol group of 20 women received a continuous oral dose of 2 mg of estr adiol valerate and 1 mg of norethisterone acetate daily. The climacter ic symptoms, bleeding patterns, endometrial thickness, and endometrial changes in biopsy samples were analyzed. Serum levels of estradiol in both groups and levonorgestrel levels in the intrauterine device grou p were also determined. RESULTS: Both treatment regimens effectively r elieved climacteric symptoms. Spotting was more common in the intraute rine contraceptive device group than in the oral therapy group for the first 3 months. After that, the proportion of women without any bleed ing was similar in both groups. Two patients in each group dropped out because of bleeding. CONCLUSION: These preliminary findings suggest t hat the levonorgestrel-releasing intrauterine contraceptive device is a useful alternative mode of progestin administration for certain sele cted women receiving estrogen replacement therapy.