Combined oral hormone replacement therapy formulations

Today, clinicians are challenged to address a womanʹs contraceptive needs during her reproductive and perimenopausal years and then provide her with a menopausal therapeutic option. This option should offer optimal symptom relief, noncontraceptive health benefits, and a good tolerability profile. The benefits of hormone replacement therapy include control of vasomotor symptoms, reduction of vulvovaginal atrophy, and protection against osteoporosis. Research also points to emerging hormone replacement therapy benefits such as protection against cardiovascular disease, colon cancer, and Alzheimerʹs disease. One of the primary considerations in the transition from oral contraceptive use to hormone replacement therapy is the tolerability profile of the progestin component of the hormone replacement therapy. Because progestin-related side effects are among the main reasons for discontinuation of hormone replacement therapy, the selection of a formulation that contains the same well-tolerated progestin as in the womanʹs oral contraceptive can be particularly important to successful use of hormone replacement therapy. Currently in the United States continuous combined hormone replacement therapy is available in 3 formulations and 1 continuous estrogen/intermittent progestin formulation. Although direct comparative trials are lacking, available data suggest that the new, continuous 17β-estradiol/intermittent norgestimate hormone replacement therapy formulation may offer advantages over regimens that contain older progestins with metabolic disadvantages. (Am J Obstet Gynecol 2001;185:S38-46.)