The effect of submucous fibroids on the dose-dependent modulation of uterine bleeding by trimegestone in postmenopausal women treated with hormone replacement therapy
Article first published online: 12 AUG 2005
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 107, Issue 3, pages 329–334, March 2000
How to Cite
Wahab, M., Thompson, J. and Al-Azzawi, F. (2000), The effect of submucous fibroids on the dose-dependent modulation of uterine bleeding by trimegestone in postmenopausal women treated with hormone replacement therapy. BJOG: An International Journal of Obstetrics & Gynaecology, 107: 329–334. doi: 10.1111/j.1471-0528.2000.tb13227.x
- Issue published online: 12 AUG 2005
- Article first published online: 12 AUG 2005
- Accepted 4 October 1999
Objective To assess the value of identifying endometrial structural abnormalities at baseline hysteroscopy in predicting the pattern of bleeding in postmenopausal women treated with hormone replacement therapy.
Design A randomised, double-blind, dose-ranging study.
Setting A teaching hospital in the UK.
Population One hundred and seventy-six healthy postmenopausal women.
Methods Women were randomised to receive one of four doses of oral trimegestone (0.05, 0.1, 0.25 and 0.5 mg per day), from day 15–28, and a daily dose of 2 mg oral micronised oestradiol for six treatment cycles. Women completed diaries in which the bleeding episodes were recorded. Hysteroscopy under local anaesthesia and endometrial biopsy were performed at baseline and on day 24 of the last treatment cycle.
Results Women with submucous fibroids had more prolonged (P= 0.026) and heavier (P= 0.002) progestogen-associated bleeding (odds ratio 4.54). The incidence of intermenstrual bleeding, but not its duration or severity, was higher in women with submucous fibroids (P= 0.017). There was a clear dose-dependent effect of trimegestone, with a consistently later onset of progestogen-associated bleeding occurring with increasing doses of trimegestone (P < 0.001), and such episodes became progressively lighter and of shorter duration over time (P < 0.001).
Conclusion Hysteroscopic evaluation of the endometrial cavity in women treated with hormone replacement therapy, predicts the occurrence of heavy and unscheduled bleeding.