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Symptomatic Menopause - What Are the Safe and Effective Options?

Geriatrics & Aging 2005;9,October 2005,51-54.

Dear Editor,

I very much enjoyed Dr. Jerrilynn Prior’s article entitled “Symptomatic Menopause--What Are the Safe and Effective Options?” in the October 2005 edition of your journal. I have three questions.

Question 1-Does Dr. Prior recommend the addition of a progestin for women with an intact uterus using vaginal estrogens for dryness/dysparunia?

Question 2-In figure 1, she suggests that women with disturbing hot flushes combined with osteoporosis take transdermal estradiol along with daily micronized progesterone at a dose of 300 mg. In the text of her article, she states that this dose of OMP is equivalent to 10 mg of MPA. This seems like a higher dose of MPA than most would use for daily dosing. Is this correct?

Question 3-Is there evidence to assure us that unopposed progestin therapy (as she suggests as treatment for severe vasomotor symptoms without osteoporosis) is safe?

Again, thanks very much for the informative article.

Sincerely,

A. Lewis
Family Medicine
Calgary, AB