Breakthrough Bleeding Patterns in Two Continuous Combined Estrogen/Progestogen Hormone Replacement Therapies,One of Which Included Androgens

A double-blind, parallel-group study was conducted in 44 healthy, naturally postmenopausal women. Half the patients (n = 22) received daily doses of 0.625 mg esterified estrogens and 1.25 mg methyltestosterone (Estratest) and 2.5 mg medroxyprogesterone (Provera) daily (E + A + P), and the other half (n = 22) received 0.625 mg conjugated estrogens (Premarin) combined with 2.5 mg medroxyprogesterone (Provera) daily (E + P). The incidence and severity of breakthrough bleeding were not significantly different between treatment groups. In the first 4 weeks of treatment, the proportion of patients experiencing bleeding was 59.1% in the E + A + P group and 52.4% in the E + P group. In the second 4-week interval (weeks 5–8), bleeding incidence decreased to 26.8% of patients in the E + A + P group and 30.0% of patients in the E + P group. Bleeding incidence remained at similar levels in the last 4 weeks of treatment, that is, 33.3% of patients in the E + A + P group and 25% in the E + P group. Treatment groups were comparable with respect to the incidence of adverse events. In this study there was no difference in bleeding patterns between the two continuous combined estrogen-progestin regimens, one of which included androgen.