Effect of different doses of progestin on uterine leiomyomas in postmenopausal women

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Abstract

Objective(s): To evaluate the effects of two doses of medroxyprogesterone acetate (MPA) on uterine leiomyoma sizes and on uterine bleeding pattern in postmenopausal women treated with oral hormone replacement therapy (HRT). Study design: Thirty natural postmenopausal women affected by uterine leiomyomas were enrolled and treated with oral micronized estradiol (E2) at dose of 2 mg per day, and randomized to receive in association MPA at dose of 2.5 mg daily (group A) or of 5 mg daily (group B). At the beginning of the study and after 1 year of treatment, uterine leiomyomata dimensions were measured using transvaginal ultrasonography (TV-USG). The subjects were instructed to note on a daily dairy the number and severity of abnormal uterine bleeding (AUB) episodes. Results: After 1 year of therapy, a significant changes in mean uterine leiomyomas size was observed in the group treated with higher dose of MPA. No significant differences in uterine bleeding were detected between the two groups. Conclusion(s): In postmenopausal women with uterine leiomyomas, it is necessary to use the minimal efficacious dose of progestin during HRT because of a higher risk to increase the tumors dimensions.

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)

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