Gynecology Book

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Continuous Estrogen Replacement

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  1. Indications
    1. Estrogen Replacement in Late post-Menopause
  2. Protocol
    1. Two pill regimen
      1. Estrogen taken daily
      2. Progestin taken daily
    2. Combination Pill (Expensive)
      1. Prempro (Premarin: 0.625 mg, Provera 2.5 mg)
  3. Estrogen Options
    1. Conjugated Equine Estrogen 0.625 mg qd
    2. See also Sequential Estrogen Replacement
  4. Progestin Options
    1. Provera 2.5 mg qd OR
    2. Norethindrone 0.35 mg qd OR
    3. Micronized Progesterone 100 mg qd
  5. Advantage over Sequential Estrogen Replacement
    1. Decreased uterine bleeding
  6. Adverse effects
    1. Decreased Libido: Consider Estratest instead Premarin
      1. Estrogen 1.25
      2. Methyltestosterone 2.5
    2. Recurrent Vaginal Bleeding
      1. Rule-out Endometrial Cancer with Endometrial Biopsy
      2. Change Estrogen Replacement regimen
        1. Estradiol 1 mg qd and
        2. Norethindrone Acetate (NETA) 0.1 to 0.5 mg qd
          1. NETA 0.1 mg: No bleeding in 79% at 1 year
          2. NETA 0.25 mg: No bleeding in 84% at 1 year
          3. NETA 0.5 mg: No bleeding in 90% at 1 year
      3. References
        1. Archer (1999) Obstet Gynecol 94:323

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