Progestational effects of combinations of gestodene on the postmenopausal endometrium during hormone replacement therapy,

Objective: The aim of the study was to assess the dose-response effects on the postmenopausal endometrium of 3 sequential combined hormone replacement regimens and 1 continuous combined hormone replacement regimen of estradiol and gestodene. Study Design: In this 2-year double-blind, placebo-controlled study, 278 healthy postmenopausal women received either 2 mg estradiol sequentially combined with 50 μg or 25 μg gestodene, 1 mg estradiol sequentially or continuously combined with 25 μg gestodene, or placebo. Results: All 4 hormone treatment regimens produced a safe endometrial histologic appearance. The regimens that were based on the lower dose of 1 mg estradiol was associated with less uterine bleeding than were those that were based on 2 mg estradiol. For sequentially opposing the 2 mg dose of estradiol, the dose of 25 μg gestodene was less efficient in producing secretory activity than was the dose of 50 μg gestodene. The measurement of placental protein 14 in serum reflected the secretory transformation of the endometrial buildup. Conclusion: The reduction in bleeding episodes associated with regimens with lower estradiol doses may lead to improved long-term therapy compliance by menopausal women. The potency of progestogens can be assessed by measuring the serum concentration of placental protein 14. (Am J Obstet Gynecol 1999;180:539-49.)