A comparative study of the effects of an estradiol-releasing vaginal ring combined with an oral gestagen versus transdermal estrogen combined with a levonorgestrel-releasing IUD: clinical findings and endometrial response.

Objective: Our purpose was to compare the effects of a new estradiol-releasing vaginal ring with an oral progestin versus the efficacy, safety and acceptability of an intrauterine device releasing levonorgestrel combined with estradiol, delivered transdermally from a patch. Climacteric symptoms, bleeding pattern, and endometrial histologic features were studied.

Materials and methods: Fifty-six parous, postmenopausal women with urogenital symptoms were allocated to two groups for 1 year" 28 women receiving estradiol by a vaginal ring (2 mg/3 months) and an oral progestin for 7 days every month and 28 women receiving a continuous transdermal daily dose of 50 micrograms of estradiol with a levonorgestrel-releasing (20 micrograms/day) intrauterine device inserted. All the patients were subjected to vaginosonographic examination followed by thorough pathological examination of uterine curetting samples.

Results: A mean endometrial thickness (double layer) of 2.9 and 3.0 mm, respectively, was found to be predictive of normal endometrium. Both treatment regimens effectively relieved urogenital symptoms. Endometrial proliferation was not observed.

Conclusions: Treatment of urogenital symptoms in postmenopausal women with these two forms of hormone replacement therapy was shown to be an effective and safe method, exhibiting possible advantages over other methods of treatment.