Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and medroxyprogesterone acetate

Wulf H. Utian, Donna Shoupe, Gloria Bachmann, Joanne V. Pinkerton, James H. Pickar

Research output: Contribution to journalArticlepeer-review

327 Scopus citations


Objective: To evaluate the efficacy of lower doses of conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) for relieving vasomotor symptoms and vaginal atrophy. Design: A randomized, double-blind, placebo-controlled trial (the Women's Health, Osteoporosis, Progestin, Estrogen study). Setting: Study centers across the United States. Patient(s): Two thousand, six hundred, seventy-three healthy, postmenopausal women with an intact uterus, including an efficacy-evaluable population (n = 241 at baseline). Intervention(s): Patients received for 1 year (13 cycles; in milligrams per day) CEE, 0.625; CEE, 0.625 and MPA, 2.5; CEE, 0.45; CEE, 0.45 and MPA, 2.5; CEE, 0.45 and MPA, 1.5; CEE, 0.3; CEE, 0.3 and MPA, 1.5; or placebo. Main Outcome Measure(s): Number and severity of hot flushes and Papanicolaou smear with vaginal maturation index (VMI) to assess vaginal atrophy. Result(s): In the efficacy-evaluable population, reduction in vasomotor symptoms was similar with CEE of 0.625 mg/d and MPA of 2.5 mg/d (the most commonly prescribed doses) and all lower combination doses. CEE of 0.625 mg/d alleviated hot flushes more effectively than the lower doses of CEE alone. VMI improved in all active treatment groups. Conclusion(s): Lower doses of CEE plus MPA relieve vasomotor symptoms and vaginal atrophy as effectively as commonly prescribed doses.

Original languageEnglish (US)
Pages (from-to)1065-1079
Number of pages15
JournalFertility and Sterility
Issue number6
StatePublished - Jun 21 2001

All Science Journal Classification (ASJC) codes

  • Reproductive Medicine
  • Obstetrics and Gynecology


  • Conjugated equine estrogens (CEE)
  • Hormone replacement therapy (HRT)
  • Lower doses
  • Medroxyprogesterone acetate (MPA)
  • Menopause
  • Postmenopausal women
  • Vaginal atrophy
  • Vaginal maturation index (VMI)
  • Vasomotor symptoms
  • Women's HOPE study

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