AMENORRHEA DURING HORMONE REPLACEMENT THE RAPY BY THE ASSOCIATION OF PERCUTANEOUS 17-BETA-ESTRADIOL AND ORAL MICRONIZED PROGESTERONE

The effects of oral micronized progesterone - administered at a low do se - on the endometrium and on bleeding pattern have been evaluated du ring a multicenter study in which 101 patients were involved. For a mi nimum of 6 months, patients who did not wish to have withdrawal bleedi ng (98) received the association of 17 beta-percutaneous estradiol (1, 5 mg / d) and oral micronized progesterone (100 mg / d, at bedtime) du ring 25 days per month (or 21 d / 28). The few women (3) who wished re gular bleeding were given progesterone (300 mg / d) with estradiol (3 mg / d), from the 16th to the 25th of the month. No hyperplasia was ob served among the endometrial biopsies performed after 6 months minimum of treatment. 8 % of the endometria were partially secretory, 4 %were sub-atrophic, 23 % were mildly active with rare mitoses and 61 % were quiescent without mitoses. The remaining 4 % were considered inadequa te. Mitotic activity of the glands was minimal in all samplings (mean < 0,53 / 1 000 cells). The average thickness of the mucosa was measure d by ultrasonography at 3,9 mm, in the cases of insufficient samplings . No bleeding (or spotting, or cyclic bleeding) occurred in 73,3 % and 80,9 % of the cycles, in the 3rd and 6th month of therapy. Therefore a low dose of oral Pg (100 mg / d) combined with E(2) during 25 days / month efficiently controls endometrial proliferation, while allowing a very weak cyclic activity. This situation makes it possible to minim ize spottings and to maintain an amenorrhea in the majority of patient s, thus letting us hoping for an improvement in the observance of this simplified therapy