Progestogen safety and tolerance in hormonal replacement therapy

  title={Progestogen safety and tolerance in hormonal replacement therapy},
  author={Santiago Palacios and Andrea Mej{\'i}a},
  journal={Expert Opinion on Drug Safety},
  pages={1515 - 1525}
ABSTRACT Introduction: Today, it is a mandatory practice to prescribe a combination of estrogens and progestogens for menopausal women requiring hormone therapy and with a uterus. The WHI study and its reanalysis demonstrate a big difference in results between the conjugated equin estrogen (CEE) only vs.CEE plus medroxyprogesterone acetate (MPA) arms in relation with breast cancer and cardiovascular risk. The conclusion is that risk is clearly higher in the arm with MPA than in the CEE only arm… 

Progestogens as a component of menopausal hormone therapy: the right molecule makes the difference

Micronized progesterone and dydrogesterone appear to be the safest options, with lower associated cardiovascular, thromboembolic, and breast cancer risks compared with other progestogens, and are the first-choice options for use in ‘special situations,’ such as in women with high-density breast tissue, diabetes, obesity, smoking, and risk factors for venous throm boembolism.

What do TSECs provide in the menopausal hormone therapy?

  • P. LlanezaJ. Calaf D. Lubian
  • Medicine
    Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology
  • 2018
The objective of this guide will be to analyze the efficacy and safety of TSEC consisting of CE/BZA in postmenopausal women.

Efficacy of progestin-only treatment for the management of menopausal symptoms: a systematic review.

A beneficial effect was reported in some trials with the transdermal route at longer duration and with oral treatment at higher doses for VMS for progesterone- only therapy, and this report may help to inform future studies of progestin-only therapy for the treatment of menopausal symptoms.

Safety and benefit considerations for menopausal hormone therapy

Differences between estrogen-alone versus estrogen-progestogen therapies, estradiol versus conjugated equine estrogens, and progesterone versus progestins were found in subsequent WHI analyses and studies examining components of various regimens.

Hormone Therapy and Effects on Sporadic Alzheimer's Disease in Postmenopausal Women: Importance of Nomenclature.

To progress forward and allow unbiased interpretation, it is no longer acceptable to group HT formulations together as a homogenous group, and differentiation between compounds that exhibit beneficial actions and those that do not and whether these effects are specific or generalized.

Hormone therapy for first-line management of menopausal symptoms: Practical recommendations

A brief historical perspective of events that led to the backlash against hormone therapy is provided, the current position of guideline groups is explored, and practical recommendations to guide first-line management of symptomatic menopausal women are provided.

Thromboembolic complications of hormonal therapy in women. Position of cardiologist

Clinical observations are provided illustrating the administration of hormonal therapy to women is reasonable to be discussed and agreed with cardiologists and/or general practitioners, and the patients would be informed about possible cardiovascular complications of such therapy for an adequate selfcontrol.

Hormone Replacement Therapy in a Patient with Hypogonadism and Coexisting Medical Conditions

A case of a 15-year-old adolescent girl with hypogonadism and coexisting medical conditions, who was evaluated for systemic hormone therapy, is presented.

High progesterone levels are associated with family history of premature coronary artery disease in young healthy adult men

Progesterone and LH levels are significantly associated with FH of P-CAD, independent of traditional risk factors for CAD.



Progestogens used in postmenopausal hormone therapy: differences in their pharmacological properties, intracellular actions, and clinical effects.

Differences in chemical structure, metabolism, pharmacokinetics, affinity, potency, and efficacy via steroid receptors, intracellular action, and biological and clinical effects confirm the absence of a class effect of progestogens.

Role of progestogen in hormone therapy for postmenopausal women: position statement of The North American Menopause Society.

Progestogen should be added to ET for all postmenopausal women with an intact uterus to prevent the elevated risk of estrogen-induced endometrial hyperplasia and adenocarcinoma.

Controversies concerning the safety of estrogen replacement therapy

Progestin may modify the effect of low-dose hormone therapy on mammographic breast density

Although hormone therapy appears to suspend breast involution, it does not increase breast density in the majority of treated women, and progestins differing in pharmacological properties may have a variable impact on breast density.

Potency of progestogens used in hormonal therapy: Toward understanding differential actions

Estrogen plus progestin and the risk of coronary heart disease.

Estrogen plus progestin does not confer cardiac protection and may increase the risk of CHD among generally healthy postmenopausal women, especially during the first year after the initiation of hormone use.

Effects of Hormone Replacement Therapy on Endometrial Histology in Postmenopausal Women: The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial

Combining CEE with cyclic or continuous MPA or cyclic MP protected the endometrium from hyperplastic changes associated with estrogen-only therapy.

Short-term and long-term effects of tibolone in postmenopausal women.

Evaluating the effectiveness and safety of tibolone for treatment of postmenopausal and perimenopausal women found it was more effective than placebo and associated with greater likelihood of bleeding, which suggests that if 18% of women taking placebo experience unscheduled bleeding, between 31% and 44% ofWomen taking tiblone will do so.