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Norethindrone Acetate and Estradiol-Induced Endometrial Hyperplasia

From the Departments of Gynecology and Obstetrics and Pathology, The Johns Hopkins Hospital, Baltimore, Maryland; Department of Pathology, Women’s and Children Hospital at University of Southern California, Los Angeles, California; Clinical Research Center, Eastern Virginia Medical School, Norfolk, Virginia; Novo Nordisk Pharmaceuticals Inc., Princeton, New Jersey; and Department of Pathology, Women’s and Children Hospital at University of Southern California, Los Angeles, California.

Address reprint requests to: Robert J. Kurman, MD Departments of Gynecology and Obstetrics and Pathology The Johns Hopkins Hospital 600 North Wolfe Street, Room 709 Baltimore, MD 21287

Objective: To identify the lowest effective continuous dose of norethindrone acetate that significantly reduces 12-month incidence of endometrial hyperplasia associated with unopposed 17ß-estradiol (E2), 1 mg.

Methods: In a double-masked, randomized, multicenter study, 1176 healthy postmenopausal women 45 years of age or older without evidence of endometrial abnormalities were given 12 months of treatment with unopposed E2, 1 mg, or continuous-combined regimens of E2, 1 mg, and norethindrone acetate, 0.1 mg, 0.25 mg, or 0.5 mg. Endometrial histology was evaluated at the end of the treatment period.

Results: Continuous-combined E2-norethindrone acetate regimens significantly reduced 12-month incidence of endometrial hyperplasia compared with unopposed E2 1 mg (P < .001). Endometrial hyperplasia occurred in 14.6% of women treated with unopposed E2 1 mg, whereas in all continuous-combined groups, the rate decreased to less than 1%. Among patients who received E2-norethindrone acetate 0.1 mg, incidence was 0.8%; among those who received 0.25 mg and 0.5 mg, it was 0.4%.

Conclusion: Continuous norethindrone acetate at doses as low as 0.1 mg combined with E2 1 mg effectively negated risk for endometrial hyperplasia associated with unopposed E2 1 mg, at least for the first year of therapy.

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