Symposium - Relevance of Progesterone in Mid Reproductive Years
Time:7:00 am - 8:45 am
Location:Room 20D - San Diego Convention Center
Lubna Pal, M.B.B.S., M.Sc. (Chair)
Genevieve Neal-Perry, M.D., Ph.D.
Needs Assessment and Description
The relevance of including progestin in a menopausal hormone
therapy (MHT) regimen lies in offering endometrial protection
against the unopposed effects of estrogen in women with a uterus.
However, the benefits of including progestin in MHT (i.e., reduced
risk of endometrial disorders such as hyperplasia and cancer) with
the use of estrogen alone are to be balanced against potential
risks and medication intolerance. Concepts of dose, duration
and route of administration are relevant for maximizing benefit
and minimizing risks of progestin in MHT users. With the increasing
spectrum of therapeutic options (progestin pills, creams, inserts
and intrauterine systems) that are now available, women and
their healthcare providers are increasingly confused as to the
optimal progestin regimen for use in menopausal women desiring
combined MHT therapy. After attending this live course, healthcare
providers will understand concepts related to dose, duration and
route of administration for maximizing benefit and minimizing risks of
progestin in MHT users.
At the conclusion of this session, participants should be able to:
- Individualize risk versus benefit of including progestin in a
- Appreciate that both dose and duration of exposure are
key determinants of progestin’s efficacy against estrogenmediated
- Identify strategies for minimizing progestin-related side
- Design treatment plans for women of varying ages and
differing risk profiles who are considering initiating MHT.
- Individualize treatment plans utilizing various progestin
formulations in varying doses and regimens.
A 53-year-old woman with bothersome vasomotor symptoms
unresponsive to non-hormonal strategies presents to discuss trial
of menopausal hormone therapy. Her last menstrual period was 4
months prior to this visit. Her personal history is significant for obesity,
a long-standing history of oligomenorrhea and benign endometrial
polyps. Her mammographic exams have been unremarkable other
than evidence of dense breast tissue; her mother died of breast
cancer at age 68. After participating in this session, in my practice I
will counsel the patient that:
- Short-term estrogen use without progesterone is a safe option for
- Use of transdermal progesterone cream offers the most optimal
- Intrauterine progesterone system offers a safe option of
progesterone delivery with minimal effects on breast tissue.
- Risks of adding progesterone to menopausal hormone regimen
outweigh potential for benefit.
- She should undergo hysterectomy.
- Not applicable to my area of practice.