With any medicine, it's always best to take the lowest effective dose.  This aims to give similar benefits with fewer side effects.  Birth control pills are now available with doses of estrogen one-fifth of what they were when they first came out on the market.  Now, according to the journal Fertility and Sterility (June 2001), women considering estrogen replacement therapy should know that a new low dose combination of estrogen and progestin worked just as well as higher doses did, with fewer side effects.  This information comes from the Women's HOPE (Health, Osteoporosis, Progestin and Estrogen) study  which took place at 57-sites with more than 2,600 healthy, postmenopausal women.

[In this study, some women received pills containing the most common estrogen dosage, 0.625 mg a day with different progestin doses. Other women were given combinations of progestin and two lower estrogen doses. One report states that combining 1.5 mg of progestin with 0.45 mg or 0.3 mg of estrogen daily was as effective as higher doses in reducing hot flashes and preventing thinning of the vaginal lining, which causes infections and painful intercourse for many older women. The other report shows the same low-dose combinations worked about as well as higher doses in preventing ``breakthrough'' bleeding, the main reason many women stop hormone therapy.]

This low-dose information is particularly important news--and a welcome development in the ongoing debate over the benefits and risks of hormone replacement therapy.  This will also be welcome news to women who have had bothersome side effects from higher dose HRT preparations--such as as irregular bleeding, bloating or breast tenderness.  Women who take HRT who don't have any side effects should probably continue taking their current dose, but they may want to ask their doctors if they should switch to a lower dose at some point in the future.

There are currently no low-dose forms of HRT which combine estrogen and progestin in one pill, but one is currently being reviewed by the FDA and may be on the market by year's end.

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Created: 7/30/2001  -  Donnica Moore, M.D.