Effects of continuous combined Dermstril and medroxyprogesterone acetate replacement therapy on climacteric symptoms and lumbar vertebral bone loss

Objective: To compare the effects of estradiol patch (Dermestril) with doses of 50 μg/24 h or 25 μg/24 h combined with medroxyprogesterone acetate 2 mg/day on vasomotor symptoms and lumbar vertebral bone loss in postmenopausal women. Methods: This was an one year prospective randomized study.40 cases of postmenopausal women were divided into Dermestril 25 (which release 25 μg estradiol per 24 hours) or Dermestril 50 group (which release 50 μg estradiol per 24 hours)(2 patch/week). Women in either group were given 2 mg medroxyprogesterone acetate orally per day and calcium concurrently. Kuppermann score was recorded, lumbar vertebral bone mineral density(L2 4 BMD) was measured by DXA, and endometrium thickness was determined by transvaginal ultrasound Results: After 1 month of treatment, Kuppermann score decreased by 60% and hot flush completely disappear in 50% women in both groups; after 12 months of treatment, no woman suffered from hot flush in Dermestril 50 group, while 21% women still had hot flush in Dermestril 25 group. After 6 months of treatment, L2 4 BMD increased significantly only in Dermestril 50 group(+3.53%), no change was found in Dermestril 25 group, and difference between the two groups was significant. After 12 months treatment, L2 4 BMD of Dermestril 50 and Dermestril 25 group increased 4.16% and 1.51% respectively, showing statistical significance ( P0.01 ). Simple hyperplasia was found in one patient with endometrium thickness 5 mm in Dermestril 50 group. During the last 3 months of treatment, vaginal bleeding rate was significantly lower in the Dermestril 25 group (16% vs 56%, P0.05 ). Conclusions: Both Dermestril 25 and Dermestril 50 can effectively relieve climacteric symptoms and prevent bone loss in postmenopausal women. The effect of Dermestril 50 on bone metabolism was superior to Dermestril 25. However, the high dose of estradiol patch could result in more frequent and longer vaginal bleeding, and the combination of Dermestril 50 with medroxyprogesterone acetate 2 mg daily perhaps can not completely protect the endometrium from hyperplasia.