Effects of tibolone and continuous combined hormone replacement therapy on bleeding rates, quality of life and tolerability in postmenopausal women.

OBJECTIVE: To compare the effects of tibolone and conjugated equine oestrogens continuously combined with medroxyprogesterone acetate on bleeding rates, quality of life (QoL) and tolerability. DESIGN: A double-blind, randomised comparative trial. SETTING: Thirty-seven centres in six European countries. POPULATION: Five hundred and one postmenopausal women, under 65 years of age with an intact uterus. INTERVENTIONS: For 12 months, women received daily treatment with tibolone 2.5 mg (n = 250), or conjugated equine oestrogens 0.625 mg continuously combined with medroxyprogesterone acetate 5 mg (CEE-MPA, n = 251). MAIN OUTCOME MEASURES: The primary outcome was vaginal bleeding rate during cycles 4-6. The secondary outcomes were vaginal bleeding rate during cycles 1-3, 7-9 and 10-13, cumulative bleeding rate, QoL, wellbeing, climacteric symptoms, urogenital complaints and tolerability. RESULTS: Treatment with tibolone led to a significantly lower bleeding rate during cycles 4-6 compared with CEE-MPA (15.0% vs 26.9%; P = 0.004); there was a similar difference during cycles 1-3. Both treatments improved QoL, wellbeing, climacteric symptoms and urogenital complaints. By intent-to-treat analysis, tibolone significantly improved sexual drive, interest and/or performance, compared with CEE-MPA at 12 months (P = 0.017). Although both treatments were well tolerated, there was a significantly lower incidence of breast tenderness with tibolone than CEE-MPA (2.4% vs 17.1%; P < 0.001). CONCLUSION: The vaginal bleeding rate during cycles 4-6 was significantly lower in women using tibolone. Both treatments improved QoL, wellbeing, climacteric symptoms and urogenital symptoms. Breast tenderness was significantly less frequent with tibolone.

The role of GnRH analogue therapy in the management of proximal fallopian tube occlusion.

Ten infertile women were diagnosed as having bilateral or unilateral proximal tubal occlusion in the presence of minimal to mild endometriosis. They were treated with GnRH analogue for 3 months. The aim was to assess the usefulness of therapy in reversing the tubal block. Diagnosis was based on hysterosalpingography, laparoscopy and hysteroscopy. At completion of therapy tubal patency was confirmed by hysterosalpingography. Three patients had bilateral cornual block whereas seven had unilateral. All patients had achieved bilateral tubal patency immediately following therapy. Four women achieved pregnancy during a follow-up of 3-20 months. Our results show that if early endometriosis causes proximal tubal occlusion (without fibrosis) GnRH analogues may be considered as the first line of treatment.