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Depo‐Medroxyprogesterone Acetate Compared With Conjugated Estrogens for the Treatment of Postmenopausal Women

Forty-three women who had undergone a natural or surgical menopause were randomized to receive either 0.625 mg of conjugated estrogens or an intramuscular injection of 150 mg of depo-medroxyprogesterone acetate (DMPA) for 25 days each month. Vasomotor symptoms were recorded before treatment for three weeks and weekly thereafter for three months. Serum estradiol (E2) and estrone (El) were measured before and during the second month of treatment, as were urinary calcium, hydroxyproline, and creatinine levels. Vasomotor symptoms decreased significantly in both groups, and this reduction was of a similar magnitude with either treatment. Whereas 18% of patients in both groups did not have a reduction in vasomotor symptoms, of those women who did benefit, vasomotor symptoms decreased 61.5 ± 7.5% with conjugated estrogens and 69.4 ± 7.7% with DMPA. Eighteen percent of patients treated with conjugated estrogens reported no vasomotor symptoms whatsoever, as compared with 33% among those treated with DMPA. Serum estrone and estradiol increased in patients receiving conjugated estrogens, but were lower in women treated with depo-medroxyprogesterone acetate. Urinary calcium/creatinine and hydroxyproline/creatinine ratios were significantly lowered to the premenopausal range in women treated with conjugated estrogens and DMPA. There were no differences in these ratios when the two treatments were compared. Adverse side effects such as vulvovaginal complaints and weight gain were negligible in both groups and the complaints of dyspareunia were similar. The data from this short-term study suggest that depo-medroxyprogesterone acetate affords a suitable alternative to estrogen therapy for reducing vasomotor symptoms and may prevent bone resorption as well.