Low dose estradiol valerate plus estriol can preserve bone loss in the forearm and attenuate climacteric symptoms in early postmenopausal women

OBJECTIVE The aim of the study was to establish whether a combi nation of low dose estradiol valerate (EV) and estriol (E3) is able to alleviate climacteric symptoms and preserve bone in early postmenopausal women. METHOD A one-year prospective non-randomized study was conducted of two groups of women: control group (n=31) and hormone replacement therapy (HRT) group (n=35), treated with 1 mg EV and 2 mg E3, combined with sequential levonorgestrel 0.25 mg. The criteria for inclusion were: 9–18 months after last menstrual bleeding, FSH>25 IU/L, moderate climacteric symptoms, bone mineral density (BMD) of less than 2.5 SD below peak adult bone mass. None of the women had any pre-existing medical condition which could affect bone metabolism. BMD was estimated by single-energy X-ray absorptiometry on the distal and ultradistal areas of the forearm at the start of the study and after 1 year. The Kupperman menopausal index (KI), Hamilton anxiety scale (HAMA), and adverse effects were recorded at baseline and at the 3rd, 6th and 12th months. RESULTS No differences in age, height, menstrual history, parity, physical activity, exposure to sunlight, coffee intake, HAMA and distal BMD were observed between the groups. In the control group body mass index (BMI) and ultradistal BMD were higher and KI lower than in the HRT group. During the study KI and HAMA decreased significantly in the HRT group compared to initial values and to the control group. BMD increased significantly in the HRT group for both distal and ultradistal areas while in the control group a significant decrease in these parameters was observed. CONCLUSIONS Treatment with low dose EV+E3 is sufficient to reduce climacteric symptoms and prevent bone loss with acceptable tolerability in early menopause.