Low-dose transdermal estradiol for symptomatic perimenopause

Revisiting estrogen: efficacy and safety for postmenopausal bone health

The rapid decline in endogenous estrogen production that occurs during menopause is associated with significant bone loss and increased risk for fragility fracture. While hormone therapy (HT) is an effective means to re-establish endogenous estrogen levels and reduce the risk of future fracture, its use can be accompanied by undesirable side effects such as stroke and breast cancer. In this paper, we revisit the issue of whether HT can be both safe and effective for the prevention of postmenopausal bone loss by examining standard and alternative doses and formulations of HT. The aim of this paper is to continue the dialogue regarding the benefits and controversies of HT with the goal of encouraging the dissemination of-up-to date evidence that may influence how HT is viewed and prescribed.

Quality of life and climacteric complaints amongst women seeking medical advice in Taiwan: assessment using the WHOQOL-BREF questionnaire

OBJECTIVE

To determine the impact of the climacteric transition on health-related quality of life amongst women, between the ages of 45 and 55 years, seeking medical advice in Taiwan.

METHOD

A total of 203 women seeking medical advice (SMA) were drawn from a special integrated clinic, with a further 349 healthy referents of the same age, range and gender, with no history of hormone replacement therapy and living in the same municipality, also being recruited from a national health survey sample for comparison. Each one was asked to fill out the brief questionnaire of the Taiwan version of the World Health Organization Quality of Life (WHOQOL-BREF), assessing quality of life on 26 items in four domains (physical, psychological, social and environmental). SMA subjects were also questioned about the 21 most frequent symptoms. Multiple regression analyses were conducted to control variables such as age, marital status, religion and educational attainment.

RESULTS

The mean scores for the physical, psychological and social domains were significantly lower than those of the healthy referents, as was the overall quality of life for SMA women. Although usual vasomotor symptoms did not significantly predict quality of life in the SMA subjects, after controlling for demographic factors, insomnia and emotional disturbance were found to be major determinants of the scores in the different domains.

CONCLUSION

Insomnia and emotional disturbance should be taken into consideration in the management of climacteric women seeking medical advice.

Lowest Effective Transdermal 17β-Estradiol Dose for Relief of Hot Flushes in Postmenopausal Women

OBJECTIVE

To investigate the efficacy of micro-dose transdermal estrogen in relieving menopausal vasomotor symptoms.

METHODS

A randomized, double-blind, placebo-controlled, multi-center trial. Healthy postmenopausal women with at least seven moderate or severe hot flushes per day for at least 1 week, or at least 50 per week, applied transdermal patches with a nominal delivery of 0.023 mg/d 17beta-estradiol and 0.0075 mg/d levonorgestrel (low-dose E2/levonorgestrel; n=145), 0.014 mg/d E2 (micro-dose; n=147), or placebo (n=133) for 12 weeks. The coprimary efficacy variables were the mean changes from baseline in frequency and severity of moderate and severe hot flushes at the week 4 and 12 endpoints.

RESULTS

At the week 12 endpoint, mean weekly frequencies of moderate and severe hot flushes were significantly reduced compared with placebo with low-dose E2/levonorgestrel (-51.80; P<.001) and micro-dose E2 (-38.46; P<.001). Severity scores were also significantly reduced with both treatments compared with placebo. At week 12 endpoint, 41.3% of women receiving micro-dose E2 were treatment responders (75% or more reduction from baseline in hot flush frequency; P=.003 compared with 24.2% placebo). In this group, the mean reduction in moderate and severe hot flushes from baseline was approximately 50% after 2, 70% after 4, 90% after 8, and 95% after 12 weeks. There were no differences between active treatments and placebo regarding adverse events.

CONCLUSION

Micro-dose E2 (0.014 mg/d) was clinically and statistically significantly more effective than placebo in reducing the number of moderate and severe hot flushes, with a 41% responder rate, supporting the concept of the lowest effective dose.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00206622

Low-dose hormone therapy in the perimenopause

OBJECTIVE

To evaluate the effects of low-dose hormone therapy (LD-HT) on bleeding pattern and vasomotor symptoms in perimenopausal women.

METHODS

In a prospective, open-label study at an University clinic, 120 perimenopausal women suffering from irregular menstrual cycles and hot flushes were randomized to micronized 17beta-estradiol 1 mg plus dydrogesterone 10 mg sequential added (LD-HT; group A: 60 subjects) or dydrogesterone 10 mg from day 15 to 28 (group B: 60 subjects). Number and severity of hot flushes and bleeding pattern were assessed throughout the study.

RESULTS

Women in group A experienced a significant reduction in number of hot flushes while no significant variation was observed in group B. The incidence of cyclic bleeding was 86% in group A and 76% in group B, the mean duration was significantly lower in group A than in group B.

CONCLUSIONS

LD-HT may control both irregular bleeding and hot flushes in perimenopausal women.

Finished herbal product as an alternative treatment for menopausal symptoms in climacteric women

BACKGROUND

There is a paucity of scientific evidence supporting the efficacy of herbal medicines in treating menopausal symptoms.

OBJECTIVE

The aim of this study was to evaluate safety and efficacy of the finished herbal product TMN-1 in the treatment of menopausal symptoms in climacteric women.

DESIGN AND SETTING

A multicenter, prospective, observational follow-up study was conducted from July 2003 to December 2004 in four hospitals in Taiwan.

PARTICIPANTS

Initially, 126 women were included who were between 45 and 55 years of age, were experiencing hot flashes, and were without hormone replacement therapy. Women were excluded if they had any signs of active cancer. Of the participants, 82% completed the study. The reasons for withdrawal included adverse effects (n = 7), failed to return (n = 7), lack of efficacy (n = 6), and from protocol deviation (n = 3).

INTERVENTION

Every participant received TMN-1 treatment 4 g, 3 times per day, for 12 weeks.

MAIN OUTCOME MEASURE

Primary measures were change in frequency of hot flashes and severity of menopausal symptoms measured by Kupperman Index (KI). Secondary outcomes included changes in quality of life and adverse events.

RESULTS

Significant improvement in scores of hot flashes and KI were found at weeks 4 and 12 in the 50 peri- and 53 postmenopausal women who completed this study (p < 0.001). Logistic regression analyses showed that perimenopausal women with hot flashes had sevenfold (95% confidence interval [CI], 1.8-28.0) odds of improvement in favor of treatment, whereas that of the postmenopausal group was 1.5 (95% CI, 0.5 to 4.2). Further analyses showed that TMN-1 produced superior benefit in women with moderate and severe menopausal symptoms (KI > or = 21), compared to those with mild symptoms. It also improved symptoms of insomnia, nervousness, melancholia, and palpitation in perimenopausal women. Five (5) adverse drug reactions were detected: three single events of nausea, abdominal pain, and abdominal fullness; and two events of diarrhea.

CONCLUSIONS

This study provides evidence that 12 weeks of TMN-1 therapy is a viable alternative treatment to consider in perimenopausal women with hot flashes, particularly in those with palpitations, emotional disturbance, and insomnia.