Combined HRT not linked to endometrial hyperplasia. (Long-Term Continuous TX).

Postmenopausal women who used continuous combined hormone replacement therapy for up to 5 years were not at increased risk for endometrial hyperplasia or malignancy in a prospective, long-term follow-up study.

Moreover, the therapy was associated with some protective benefits, Dr. Michael Wells of the University of Sheffield (England) and his colleagues reported.

After an average duration of 4.4 years of hormone replacement therapy (HRT) use, endometrial histology in 534 postmenopausal women revealed that none of those with an assessable uterus had endometrial hyperplasia or malignancy including 21 who had been diagnosed with complex hyperplasia before starting the therapy (BMJ 325[7358]:239-42, 2002).

The women were recruited from menopause clinics throughout the United Kingdom and were treated with 2 mg daily of 17-oestradiol and 1 mg daily of norethisterone--doses that are double those typically used in the United States for comparable HRT combinations, Dr. Wulf Utian, executive director of the North American Menopause Society, said in an interview.

In terms of the endometrium, these findings give reassurance of the long-term safety of continuous combined HRT, the investigators said, noting that this regimen even led to reversal of complex hyperplasia in women who developed the condition while taking sequential or unopposed HRT. Previous studies of the effects of HRT on the endometrium have failed to evaluate long-term outcomes, and safety data have been lacking.

Research has shown that sequential therapy is associated with an increased risk to the endometrium when used for longer than 5 years and when the ...