Гинекология (Feb 2015)

The efficacy of 17β-estradiol and low dosed drospirenone use in postmenopausal women (literature review)

  • E N Andreeva,
  • O R Grigoryan,
  • Yu S Absatarova

Journal volume & issue
Vol. 17, no. 1
pp. 34 – 40

Abstract

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Vasomotor symptoms, including hot flushes (HF), are the most common symptoms of menopause, requiring treatment with estrogen and/or progestogen. Recent international guidelines recognize the need to use the lowest effective dose of hormone replacement therapy. Drospirenone (DR) in combination with 17-estradiol (E) is used as hormone therapy (HT) for relief the symptoms and prevention of postmenopausal osteoporosis.The aim of this review is a meta-analysis of studies examining the efficacy and safety of low-dose DR and E for the treatment of vasomotor symptoms inpostmenopausal women.The review presents data of 2 large randomized controlled studies that evaluated the lowest effective dose combination DR/E, the safety of this dose for endometrium, identified features of its pharmacodynamics and pharmacokinetics, depending on various factors.In the first, a study of the lowest effective doses of DR/E for the treatment of HF in postmenopausal women was made. It led to the conclusion that the com-bination of DR 0,25 mg/E of 0,5 mg is the minimum effective dose. Efficacy of low doses of DR/E correlated with exposure DR and E in serum, while smoking had a negative impact on the Efficacy of treatment.Another study assessed the risk of endometrial hyperplasia and bleeding pattern in patients receiving 0,25 mg DR/E of 0,5 mg for 12 months. At the end of the study no evaluable women in the DR/E2 group had an endometrial biopsy result of hyperplasia or worse, which endometrial confirmed the safety of receiving DR 0,25 mg/E of 0,5 mg.Thus, the minimum effective dose for the relief of HF without causing any significant impact on the endometrium is DR of 0,25 mg/E of 0,5 mg. According to the results of the pharmacokinetic study a correlation between effectiveness of low dose DR/E with DR and E exposure levels was showed, and smoking reduces the effectiveness of hormonal therapy. This drug not only copes with moderate to severe hot flashes, but also reduces the incidence of symptoms of vulvovaginal atrophy, improving quality of life.

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