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BENEFITS OF COMBINED CONTINUOUS HORMONE REPLACEMENT THERAPY.

In response to side effects experienced by patients on cyclic regimens for hormone replacement therapy -- most notably uterine bleeding -- continuous regimens of combined estrogen and progesterone have been studied. In this meta- analysis, researchers at the University of Maryland examined the benefits and consequences of such therapy. A standard literature search for English-language studies from 1981 to 1995 identified 42 relevant studies of nearly 4000 patients. Twenty-nine studies were randomized; the remaining 13 were case series. The average follow-up was about 12 months, although some patients were followed for up to 10 years. Overall compliance with the continuous regimens (usually conjugated equine estrogen 0.625 mg/day and medroxyprogesterone acetate 2.5 mg/day) was about 80 percent for 12 months. Vasomotor symptoms improved in almost all treated women. Irregular bleeding was generally a problem for the first 6 months of treatment, after which amenorrhea occurred in over 75 percent of patients. Atrophic endometrium was found in over 90 percent of patients undergoing endometrial biopsy, and hyperplasia in less than 1 percent. There were only two cases of adenocarcinoma -- both in patients with atypical endometrial hyperplasia. Lipid profiles improved significantly, with a decline in total and LDL cholesterol and an increase in HDL cholesterol. Bone mineral density showed either no change or a slight increase. Comment: This meta-analysis supports the use of continuous regimens, which are generally well accepted by patients, for hormone replacement therapy.

— TL Schwenk

Published in Journal Watch General Medicine August 29, 1995

Citation(s):

Udoff L, et al. Combined continuous hormone replacement therapy: a critical review. Obstet Gynecol 1995 Aug 86 306-316.

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