Evaluation of bleeding patterns in postmenopausal women under continuous or sequential hormone therapy

Abstract Background: The improved uterine bleeding profile in postmenopausal women receiving hormone therapy likely enhance compliance with hormone replacement therapy. Objective: To compare the bleeding patterns in post menopausal women receiving continuous or sequential hormone therapy. Methods: This quasi-experimental clinical trail was performed on 44 healthy postmenopausal women < 65 years old with intact uterus who were presented for gynecologic examination at Bouali hospital in Tehran (Iran) during 2001-2002. The patients were divided into two groups marked as group I including postmenopausal women on oral replacement with estrogen conjugate 0.625 mg and medroxyprogesterone 2.5 mg daily, in a continuous combined fashion, and group II composed of post menopausal women on oral replacement with estrogen conjugate 0.625 mg daily and medroxyprogesterone 5 mg during the last 14 days of each month. The patients were followed up for one year. The data on bleeding patterns and their relationship with duration of menopause and body mass index were analyzed statistically using 2 and Fisher exact tests. Findings: The mean menopause age was 53±4.7 and 45.2±2.2 years in group I and II, respectively. There was a significant difference between two groups, statistically (p<0.001). The mean menopause duration was 3.8±2.8 years in group I and 1.1±0.8 in group II with a statistically significant difference between two groups (p=0.01). The difference in body mass index between two groups was insignificant, statistically. All women in group I (22/100%) were found to have amenorrhea after one year. Among the patients in group II, one (14.3 %) suffered spotting, 5 (71.4%) with regular bleeding and 1 (14.3%) with amenorrhea following the same time period. The difference in bleeding patterns between two groups was shown to be statistically significant (p=0.000). Conclusion: While unexpected vaginal bleeding in women using continuous combined HRT decreased after 1 year, the degree of bleeding among those using cyclic HRT remained unchanged.