research day - University of Toronto Department of Obstetrics and ...

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ABSTRACT #P-B4
ENDOMETRIAL PROTECTION AND SYMPTOM CONTROL OF A NOVEL REGIMEN
OF COMBINATION HORMONE REPLACEMENT THERAPY USING VAGINAL
PROGESTERONE
Jamie Kroft[R], Natalie Klostermann, Evan Taerk, Wendy Wolfman.
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto.
Objectives: To conduct a retrospective review of safety and efficacy for women on a novel
regimen of hormone replacement therapy (HRT) using vaginal prometrium.
Study Methods: We conducted a retrospective chart review of menopausal patients aged 48-64
identified at the Menopause Clinic at Mount Sinai Hospital who started taking HRT at least one
year ago, consisting of an estradiol patch and vaginally administered prometrium. We collated
available transvaginal ultrasound measurements of endometrial thickness and endometrial biopsy
results after at least one year of HRT use. We also reviewed symptom relief, bleeding and side
effects.
Results: We identified 37 patients who were started on HRT consisting of an estrogen patch
ranging from 25-50ug twice weekly and vaginal prometrium either continuously 3-5 days weekly
(32 patients), or sequentially 12 days/month (5 patients). Thirteen patients were either lost to
follow-up or discontinued HRT within one year. Only 17.6% of patients who had transvaginal
ultrasounds after one year (3/17 patients) had a thickened endometrial lining on ultrasound
(>5mm), all of whom had subsequent normal endometrial biopsies. There was vaginal bleeding in
only 33.3% of patients within one year. All 24 patients had relief of their menopausal symptoms,
and only one patient experienced breast tenderness, which improved after changing to sequential
administration of vaginal prometrium. Five patients required the addition of local estrogen for
relief of vaginal dryness.
Conclusions: Vaginal administration of progesterone has the potential for decreasing side effects
(such as breast tenderness and dizziness) while maintaining endometrial safety. Larger prospective
trials are warranted.