For women with an intact uterus, the hormonal replacement therapy should consist of estrogen combined with a progestogen to eliminate the increased risk of endometrial hyperplasia and carcinoma. But sequentially added progestogen induced
withdrawal
bleeding in 80% to 90%, so complance is very poor in cyclic therapy. The most attractive aspect of continuous combined therapy is the absence of a withrawal bleeding. In general, there is a high incidence of irregular bleeding in the first 3
months
of
therapy; however most are amenorrheic by 12 months of therapy. There has been reported about variable effect on bleeding pattern of body weight, body mass index, age of menopause, and duration of amenorrhea. To evaluate the vaginal bleeding
patterns in
continuous combined estrogen-progestogen therapy, 0.625mg conjugate equine estrogen and 2.5mg medroxyprogesterone acetate were daily medicated in 70 postmenopausal women for at least 6 months. No vaginal bleening or only vaginal spotting within 3
months
has showed in 40 women(57%)(Group 1). All these women continued hormone replacement therapy for 6 months. 30 women have continued vaginal bleeding until 3 months or heavy vaginal bleeding (43%) so that the continous combined administration was
stopped
or changed to the sequential administration(Group 2). There were no statistically significant differences in body mass index, duration of amenorrhea and age of menopause.
But, there were less bleeding and so better compliance in patients weighing <57kg. So it can be supposed that when administered continuously combined the patient weighing over 57kg should be educated before treatment that she would have more
common
irregular vaginal spotting in the first 3 months of therapy.
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