Perimenopausal patients: treatment with continual escalating-dose synthetic estrogen with added progestogen.

The efficacy of 4 different escalating dosage schedules of synthetic estrogen (ethinyl estradiol or EE) for control of perimenopausal symptoms is assessed in 338 patients aged 35 to 72 during 2744 treatment cycles. Doses used ranged from 0.025 to 0.15 mg daily of EE and 10 mg daily of medroxyprogesterone acetate was added to the regimen for the terminal 7 days of each schedule (randomly selected patients taking schedule C did not receive the progestogen to allow evaluation of endometropic effects of the regimen). 57 of the patients had had hysterectomy with bilateral salpingo-oophorectomy. In most patients symptomatic relief was achieved within 4 to 8 weeks of therapy and maintained during treatment period. 22% of patients taking schedule D (Profen) had mild recurrence of symptoms (sensations of warmth sweating and flushes) during therapy but episodes were self-limited disappearing within a few weeks without change in medication. Of 59 patients on Schedule A (Meno-tabs) 5 experienced slight symptomatic relief 41 had moderate relief and 13 had marked relief. Of 21 patients in Schedule B (15-AT) 4 had slight relief 13 moderate relief and 4 marked relief. Of 18 patients on Schedule C (52BA) 1 had slight relief 13 moderate relief and 4 marked relief. 87 Scheule D patients experienced marked relief--the best results observed among the 4 treatment groups. Medroxyprogesterone acetate component of the regimen induced progestational effects in most endometrial biopsies obtained from Schedule C patients and prevented hyperplastic changes in all. There were no reported serious side effects. The study suggests that the escalating dose estrogen with added MPA is an effective and safe treatment for perimenopausal symptoms.