Evaluation of oral medroxyprogesterone acetate in the treatment of endometriosis.

Medroxyprogesterone acetate was administered orally at the daily dose of 50 mg for four months to 21 symptomatic women with moderate to severe endometriosis, staged according to the American Fertility Society classification. The efficacy of the therapy was evaluated prospectively by the patients' symptomatology, monthly pelvic examinations, and by restaging the disease at second-look laparoscopy during the last week of treatment. The effects of therapy on the serum gonadotropin and ovarian steroid levels and on the endometrium and the implants of endometriosis were also evaluated. Improvement of symptoms, pelvic nodularity, and tenderness occurred in 80% of the patients. The mean stage score of disease by the American Fertility Society classification decreased from 18.2 +/- 2 before therapy to 5.9 +/- 1 after therapy (P less than .005). Amenorrhea, breakthrough bleeding, and persistent cyclic bleeding occurred in 75, 20, and 10% of the patients, respectively. Ovulation was inhibited in all patients, but serum hormone changes were statistically significant only for LH, which decreased from 9.5 +/- 4 to 5.2 +/- 2 IU/L (P less than .001), and estradiol (E2), which decreased from 80 +/- 30 to 46 +/- 26 pg/mL (P less than .02). Atrophic changes and pseudodecidualized reaction occurred in both the endometrium and the implants of endometriosis. In summary, oral medroxyprogesterone acetate is effective in relieving symptoms and objectively improving endometriosis. Besides inducing a pseudodecidualized reaction and atrophic changes in the endometrium and ectopic implants, medroxyprogesterone acetate also suppresses ovulation and the serum levels of both LH and E2.

Clinical and metabolic responses of menopausal women to sequential versus continuous estrogen and progestin replacement therapy.

To minimize the cyclic menstrual bleeding associated with the sequential administration of estrogen and progestin in menopausal women, medroxyprogesterone acetate at the daily dose of 10 mg orally was administered, either sequentially for ten days of each 25-day treatment cycle or continuously with conjugated equine estrogen for three months. Cyclic menstrual bleeding occurred in all ten patients on sequential therapy; their endometrial histology was secretory in six, proliferative in two, and adenomatous hyperplasia in one. Of the ten patients on continuous therapy, four were amenorrheic and six experienced acyclic bleeding, but the endometrial histology was atrophic or inactive in all ten. The continuous treatment group experienced a statistically significant decrease in the mean serum levels of total cholesterol, whereas the serum levels of both low- and high-density cholesterol fractions decreased slightly. However, the sequential group experienced no change in serum levels of total cholesterol, a slight rise in high-density lipoprotein, and a significant decrease in low-density lipoprotein cholesterol fractions. Our data suggest that the combined and continuous use of conjugated equine estrogen and medroxyprogesterone acetate effectively relieves menopausal symptoms, decreases the frequency of uterine bleeding, induces endometrial atrophy, and significantly decreases serum levels of total cholesterol.