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Lower-dose Hormone Therapy Improves Menopause Symptoms with Lower Side Effect Rates: Presented at NAMS

By Denise Mann
Special to DG News

CHICAGO, IL -- October 4, 2002 -- Contrary to previous findings, lower doses of conjugated equine oestrogen either alone (CEE) or combined with medroxyprogesterone acetate (MPA) does not cause urinary symptoms, according to new data on a sub-group or patients from the Women's Health, Osteoporosis, Progestin, Estrogen (Women's HOPE) study.

The new study was presented October 3^rd at the 13^th Annual Meeting of the North American Menopause Society (NAMS) in Chicago, Illinois, by Dr. Wulf H. Utian, PhD, a consultant gynaecologist at the Cleveland Clinic in Cleveland, Ohio, and the honorary founding president and executive director of the NAMS.

The study reviewed treatment-emergent reports of dysuria, polyuria, urinary frequency, urgency or incontinence among 749 healthy postmenopausal women with intact uteri. The subjects were randomised to one year of CEE 0.625, CEE 0.625/MPA 2.5, CEE 0.45, CEE 0.45/MPA 2.5, CEE 0.45/MPA 1.5, CEE 0.3/MPA 1.5 or placebo and then continued treatment in a two-year sub-study.

The double blind, multicentre trial found that monotherapy or combination therapy did not affect the number of reports or urinary symptoms compared with placebo. Overall, the number of treatment-emergent reports of urinary symptoms was small. Less than 1 percent reported dysuria, urinary frequency, urinary urgency or polyuria and 1 percent reported urinary incontinence. There was no significant differenced between groups in the number of patients reporting urinary symptoms, the study showed.

There is conflicting evidence regarding the effects of oestrogen replacement therapy and hormone replacement therapy on urinary symptoms in postmenopausal women. Notably, the Heart and Estrogen/Progesterone Replacement Study (HERS) showed that the CCE/MPA regimen was associated with a worsening of urinary incontinence. However in the HERS trial, patients had a mean age of 67 and a body mass index of 55 percent was less than 27 kg/m2. Oestrogen affects urethral mucosa, smooth muscle and a-andrenergic tone and may thus impact urinary symptoms.

The new data, however, do not support the results of the HERS trial, said lead study researcher, Dr. Utian.

"Clearly what's happening here is that maybe we have been overdosing menopausal women," he said. "You can get the benefit of menopause-related symptom relief with lower side effect rates."

Wyeth Research funded the study.

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