Estroprogestative combinations - Hormone replacement therapy
For a replacement therapy, estrogen and progesterone can obviously be taken separately but in practise .they are combined. The estrogen is estradiol (and not ethinylestradiol) and the progestin one of the following: cyproterone, medroxyprogesterone, norethisterone or dydrogesterone.
The combinations intended for a discontinuous treatment, with 7 days discontinuation, are presented in the form of 21 active tablets (often plus 7 inactive tablets of a different colour in order to improve adherence). During the week of interruption there is generally a withdrawal bleeding.
Those which are intended for a continuous treatment, without discontinuation, are in platelets of 28 tablets. Estradiol is the estrogen and the progestin one is norethisterone, dydrogesterone, médroxygesterone, dienogest, gestodene or drospirenone.
There are estroprogestative combinations in patches, by percutaneous route.
Tibolone and its active metabolites have estrogenic, progestational and androgenic. activities. According to a clinical study, tibolone activity, used as hormone replacement therapy of the menopause, could increase the risk of endometrial cancer, probably because its progestational effect is not sufficient to compensate for its estrogenic effect.
Hormone replacement therapy after the menopause reduces the risk of fractures by osteoporosis and was supposed to reduce the frequency of the cardiovascular accidents and perhaps of Alzheimer disease. It was based on the simple idea that the compensation of the fall of the hormones after the menopause delayed ageing. Recent studies showed that the sustained THS of the menopause had limited beneficial effects, hardly different from those of the placebo, and in addition increased the risk of breast cancer and the risk of thromboembolic disorders and cardiovascular events.
In 2006 the tendency is to limit the prescription of combined oral contraceptives to the treatment of the disorders of the perimenopause and to use low dosage during a short time.
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