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Postmenopausal uterine bleeding profiles with two forms of continuous combined hormone replacement therapy
Obstetrics and Gynecology Publications and Presentations
  • Julia V. Johnson, University of Massachusetts Medical School
  • Michael Davidson, Chicago Center for Clinical Research
  • David Archer, Eastern Virginia Medical School
  • Gloria Bachmann, University of Medicine and Dentistry of New Jersey
UMMS Affiliation
Department of Obstetrics and Gynecology
Publication Date
Document Type
Aged; Double-Blind Method; Drug Combinations; Estradiol; Estrogen Replacement Therapy; Estrogens; Estrogens, Conjugated (USP); Female; Humans; Medroxyprogesterone Acetate; Middle Aged; Norethindrone; Postmenopause; Progestins; Uterine Hemorrhage

OBJECTIVE: This study was designed to compare the bleeding profiles of conjugated equine estrogens 0.625 mg in combination with 2.5 mg medroxyprogesterone acetate (Prempro; CEE/MPA group), the most widely prescribed continuous combined hormone replacement therapy (CCHRT) in the United States, with 17beta-estradiol 1 mg combined with 0.5 mg norethindrone acetate (Activella; E(2)/NETA group), a newly available CCHRT preparation, over a 6-month period.

DESIGN: This study was a prospective, randomized, multicenter, double-blind, controlled trial. A total of 438 healthy postmenopausal women were randomized and received treatment (Activella n = 217, Prempro n = 221). Each woman recorded bleeding diaries daily. Total cholesterol, triglycerides, and endometrial biopsies were obtained at screening and end-of-trial visits.

RESULTS: The more favorable bleeding profile was found in the E(2)/NETA (Activella) group. The differences in bleeding patterns were most marked in the first 3 months of treatment in women who were 1-2 years from last menses, with no bleeding in 71.4% vs. 40.0%; ( p = 0.005) and with no bleeding and no spotting in 54.8% vs. 17.1%; (p = 0.001). Triglycerides fell by 8.5% in the E(2)/NETA group and increased by 11.7% in the CEE/MPA group (p < 0.001). Total cholesterol declined by 9.1% and 6.9%, respectively.

CONCLUSION: The most important factor in the continuation of HRT is uterine bleeding. E(2)/NETA has significantly less bleeding than the most commonly prescribed CCHRT CEE/MPA, therefore; E(2)/NETA should be associated with improved continuation rates. The patient taking E(2)/NETA will receive effective treatment for her menopausal symptoms with less bleeding.


Menopause. 2002 Jan-Feb;9(1):16-22. Link to article on publisher's website


At the time of publication, Julia Johnson was not yet affiliated with the University of Massachusetts Medical School.

Related Resources
Link to Article in PubMed
PubMed ID
Citation Information
Julia V. Johnson, Michael Davidson, David Archer and Gloria Bachmann. "Postmenopausal uterine bleeding profiles with two forms of continuous combined hormone replacement therapy" Vol. 9 Iss. 1 (2002) ISSN: 1072-3714 (Linking)
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