European Journal of Obstetrics & Gynecology and Reproductive Biology
Effect of different doses of progestin on uterine leiomyomas in postmenopausal women
Introduction
Sener et al. [1] showed that 1 year of hormone replacement therapy (HRT) consisting in transdermal estradiol (E2) plus 5 mg daily of medroxyprogesterone acetate (MPA) increases the size of uterine leiomyomas in postmenopausal women [1]. In the same study, no modification was reported after oral HRT with 2.5 mg daily of MPA [1]. At present, it is not clear if this increase was due to different estrogen route administration or for the higher dose of progestin used during transdermal HRT.
Recently, in other two studies [2], [3], it is observed a significant increase in uterine dimensions after administration of MPA 10 mg per day sequentially added to E2. Furthermore, different doses and types of progestins, and various regimens of administration were used [1], [2], [3]. In addiction, no study has been designed with a real control group.
The aim of this study is to evaluate the effects of two different doses of MPA on uterine leiomyoma dimensions and on uterine bleeding pattern in postmenopausal women treated with oral HRT.
Section snippets
Materials and methods
Thirty natural postmenopausal women affected by uterine leiomyomas were enrolled in the study. The study was approved by the Local Ethics Committee and all subjects gave their written informed consent.
The inclusion criteria were: spontaneous menopause for at least 1 year and less than 2; history of uterine leiomyomas; presence of no more than two uterine leiomyomas measuring >20 mm at transvaginal ultrasonography (TV-USG). The exclusion criteria were: neoplastic; metabolic and infectious
Results
Twenty-seven subjects completed the study. At the beginning of the study, there was no significant difference among the groups in age, time since menopause, BMI, parity, and endometrial thickness (Table 1).
No significant difference was observed among the two groups in uterine leiomyoma sizes at entry (Table 1).
After 1 year of therapy, no significant differences were observed between the two groups of treatment in mean uterine leiomyomas sizes (Table 1). Furthermore, a significant (P<0.05)
Comment
A significant increase in uterine leiomyoma sizes was detected in postmenopausal women using transdermal E2 plus MPA 5 mg per day [1]. On the contrary, in the same study no modification was reported after oral conjugated equine estrogens plus MPA 2.5 mg per day [1]. Recently, a significant increase in leiomyoma dimensions was also observed in postmenopausal women treated with transdermal E2 plus MPA 10 mg per day in a sequential cyclic regimen [2]. Indeed, an onset of new leiomyomas was observed
References (4)
- et al.
Uterine myoma in postmenopause: a comparison between two therapeutic schedules of HRT
Maturitas
(2000) - et al.
A randomized study of the effects of tibolone and transdermal estrogen replacement therapy in postmenopausal women with uterine myomas
Eur. J. Obstet. Gynecol. Reprod. Biol.
(2000)
Cited by (29)
Menopausal hormone therapy in women with benign gynaecological conditions and cancer
2021, Best Practice and Research: Clinical Endocrinology and MetabolismCitation Excerpt :There were inconsistent effects of MHT on fibroid growth with four studies demonstrating an increase in fibroid size or development of new fibroids, while five studies showed no significant effect on fibroid growth [10]. Some studies demonstrating an increase in fibroid size utilised different progestin regimens, particularly varying doses of medroxyprogesterone acetate [13–15], highlighting the significant role of progestins in fibroid growth. However, the overall heterogeneity in data, as well as the small sample sizes and limited follow-up in many of the included studies, limits the generalisability of this data.
Chapter 20 - Uterine Mesenchymal Tumors
2017, Diagnostic Gynecologic and Obstetric PathologyFibroid growth and medical options for treatment
2014, Fertility and SterilityCitation Excerpt :Proliferation markers are overexpressed in fibroids during the luteal phase (68), as well as in postmenopausal women treated with estrogens and progestins, but not with estrogens only (69). In postmenopausal women, the stimulatory effect of hormone replacement therapy on fibroid growth has been correlated with the progestin dose (70). Whereas treatment with GnRH analogues results in fibroid shrinkage, cotreatment with progestins limited their therapeutic efficacy (71).
Medical treatment of symptomatic uterine leiomyomata in premenopausal woman
2013, Presse MedicaleRole of medical treatment for symptomatic leiomyoma management in premenopausal women
2011, Journal de Gynecologie Obstetrique et Biologie de la ReproductionImpact of uterine diseases on fertility
2010, Revista Medica Clinica Las Condes