Continuous intrauterine compared with cyclic oral progestin administration in perimenopausal HRT

Abstract Objectives: Two hormone replacement therapy (HRT) regimens of combined oral estradiol with either continuous intrauterine or cyclic oral progestin were compared for 2 years. Methods: 200 perimenopausal women randomly received an intrauterine system with continuous levonorgestrel release (20 μg/24 h) combined with oral estradiol (2 mg daily), or a cyclic oral regimen of norethisteroneacetate (1 mg on day 13–22) and estradiol (days 1–21; 2 mg, days 22–28; 1 mg). Efficacy on endometrial protection, vaginal bleeding patterns, blood loss and practical use were compared during 26 cycles. Results: Endometrial protection was adequate in both regimens. The cyclic regimen induced a more regular bleeding pattern. The continuous local administration induced a reduction in bleeding ( P =0.001) with an initial period of prolonged and frequent bleeding. 38% became ameorrhoeic. Women found both regimens acceptable. Conclusions: Continuous intrauterine Levonorgestrel administration by using an intrauterine system can well be recommended for use in combination with oestrogen replacement therapy in perimenopausal women.