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Query: UMLS:C0745411 (irregular bleeding)
 386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Irregular menstrual bleeding is a common reason for discontinuation of depot medroyprogesterone acetate (DMPA) contraception. We conducted a double-blind, randomized placebo controlled trial to estimate if transdermal estradiol used in a cyclic fashion could make DMPA bleeding patterns more acceptable and improve DMPA continuation rates. Women initiating DMPA contraception immediately post-abortion (N = 132) were randomized to receive either a low sustained dose of transdermal 17-beta estradiol (0.10 mg/day, Climara) or an identical placebo to be used in a cyclic manner for 3 months. Bleeding patterns, contraceptive use, and pregnancy rates were measured for 1 year after enrollment. Cyclic transdermal estrogen did not create regular bleeding patterns in new users of DMPA and had no effect on DMPA continuation rates (relative hazard = 0.93, 95%CI 0.65-1.33). By 12 months after enrollment, 19.4% of those randomized to estrogen and 23.9% of those randomized to placebo were still using DMPA for contraception. There was no difference in the frequency of DMPA discontinuation primarily for abnormal uterine bleeding between groups (relative risk ratio = 0.95, 95%CI 0.40-2.23). Few women who discontinued DMPA switched to highly effective methods of contraception and within 1 year of an abortion, there were 18 repeat pregnancies (21.9%). Compliance with the estrogen patches was poor resulting in early study termination and inadequate statistical power to detect a clinically significant difference in DMPA continuation rates. Continuation rates of DMPA were low and repeat pregnancy rates were high among women initiating DMPA at the time of abortion. Cyclic transdermal estradiol use is an unacceptable regimen for preventing the irregular bleeding associated with DMPA initiation.
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PMID:Post-abortion depot medroxyprogesterone acetate continuation rates: a randomized trial of cyclic estradiol. 1241 14

Hormone replacement therapy (HRT) is recognized as the 'gold standard' for the treatment of the short- and long-term consequences of estrogen deprivation. Compliance with HRT is poor, mainly due to side-effects and fear of cancer. Many women discontinue the treatment prematurely and will not derive its full benefit. This presentation summarizes the results of studies assessing the safety and tolerability of pulsed estrogen therapy (Aerodiol) versus conventional estrogen therapy. The mammary safety was assessed in well-recognized experimental models. In comparison with oral administration, pulsed therapy showed a significantly lower rate of tumor induction (p < 0.05) and reduced tumor growth. The endometrial safety of Aerodiol was assessed in a long-term study. After 1 year of treatment, 311 biopsies could be evaluated: 34% were atrophic, 16% proliferative, 39% secretory, 4% menstrual and 7% had no endometrial tissue. No cases of endometrial hyperplasia or cancer were detected. In a comparative study comprising 659 women, a lower frequency of irregular bleeding was reported with Aerodiol compared with orally administered estradiol. In two randomized studies, the frequency of mastalgia has been found to be significantly lower with Aerodiol compared with orally and transdermally administered estradiol. Aerodiol has been found to be well-tolerated, with better gynecological acceptability than conventional estrogen, and individualization of therapy might increase compliance. Intranasally administered estradiol is an attractive alternative for many women.
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PMID:Safety and tolerability of pulsed estrogen therapy: key factors for an improved compliance. 1248 10