OBJECTIVETo evaluate the effect of Premarin and Kuntai capsule (a traditional Chinese patent medicine) on the quality of life (QOL) and their cost-utility in early postmenopausal women.

METHODSFifty-seven women with menopausal syndrome in the early postmenopausal stage were randomly allocated into Premarin group (0.3 mg/day and 0.6 mg/day alternately, n=29) and Kuntai group (4 g/day, n=28). The therapies lasted for one year and the patients were followed up every 3 months. The QOL of the patients was evaluated and the utility scores were obtained from rating scale to conduct a cost-utility analysis (CUA).

RESULTSAt each follow-up examination, no significant difference was found in the QOL between the two groups (P>0.05). The QOL obviously increased after the 1-year-long therapy in both the groups, and Kuntai required longer treatment time than Premarin to take effect. The cost-utility ratio of Premarin and Kuntai were 13581.45 yuan/QALY (quality adjusted life year) and 25105.12 yuan/QALY, respectively. Both incremental cost analysis and sensitivity analysis showed that Kuntai was more costly than Premarin. The result of per-protocol analysis was consistent with that of intention-to-treat analysis.

CONCLUSIONAt early stage of menopause, the QOL of women with menopausal syndrome can be significantly improved by low-dose Premarin and Kuntai capsule, but the latter is more costly.

Cost-Benefit Analysis ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; economics ; therapeutic use ; Estrogens, Conjugated (USP) ; economics ; therapeutic use ; Female ; Humans ; Middle Aged ; Phytotherapy ; Postmenopause ; drug effects ; Quality of Life

BACKGROUND: Many experimental and observational studies have suggested that hormone replacement therapy (HRT) in postmenopausal women is cardioprotective. However, the results of randomized controlled trials have been discouraging. We attempted to evaluate the influence of overweight, a frequent risk factor for coronary artery disease, on the lipid-modifying effects of HRT. METHODS: A total of 345 postmenopausal women were divided into 2 groups according to body mass index (BMI) : the control group; BMI < 25 Kg/m2 (n=248) and the overweight group; BMI > or=25 Kg/m2 (n=97). All women received either 0.625 mg conjugated equine estrogen (CEE) (n=139), CEE plus 5 mg medroxyprogesterone acetate (MPA) (n=97) or CEE plus 10 mg MPA (n=109). Lipid profiles were measured before and 12 months after HRT. RESULTS: In both the control and overweight groups, HRT reduced low density lipoprotein cholesterol (LDL-C) (p=0.000 and p=0.000 respectively) and lipoprotein (a) [Lp (a) ] levels (p=0.000 and p=0.000 respectively) and raised high density lipoprotein cholesterol (HDL-C) levels (p=0.000 and p=0.002 respectively). However, the elevation of the HDL-C level was higher in the control group than in overweight group (17.5% vs. 10.4%, p=0.015), and this was significant after adjusting for changes in body weights (p=0.016). There were no differences in the reduction of LDL-C (p=0.20) and Lp (a) (p=0.09) levels between the two groups. CONCLUSION: HRT had less favorable effects on HDL-C levels in overweight postmenopausal women than in women with normal body weight. This finding may be partially associated with no cardioprotective effect of HRT in postmenopausal patients at a high risk due to multiple risk factors including obesity.
Contraceptive Agents, Female/therapeutic use ; *Estrogen Replacement Therapy ; Estrogens/therapeutic use ; Estrogens, Conjugated (USP) /therapeutic use ; Female ; Humans ; Lipoproteins/*blood ; Medroxyprogesterone 17-Acetate/therapeutic use ; Middle Aged ; Obesity/*blood ; Postmenopause/*physiology

OBJECTIVETo explore the therapeutic effect of Chinese medicinal massage with nourishing-Shen and activating-blood manipulation in treating women with climacteric syndrome and its influence on endocrinal function.

METHODSSixty patients were assigned to two groups, the 40 patients in the treated group were treated by Chinese medicinal massage for 20 min once every other day; the 20 patients in the control group were treated by hormone replacement therapy with Premarin 0.625 g, once daily by oral taking. The therapeutic efficacy was evaluated after two-month treatment by changes of serum levels of estradiol (E2), follicular stimulating hormone (FSH), luteinizing hormone (LH), and Kupperman index before and after treatment.

RESULTSKupperman index showed that the total symptom score in the treated group was improved from 30.71 +/- 8.43 scores before treatment to 8.21 +/- 5.14 scores after treatment, with a decrement of 22.50 +/- 8.14 scores, which was higher than that in the control group, from 24.32 +/- 5.44 scores to 5.92 +/- 3.58 scores, with a decrement of 18.40 +/- 4.50 scores, the difference between them was statistically significant (t = 2.52, P = 0.014). The serum level of E2 increased in both groups significantly after treatment, from 20.23 +/- 20.78 ng/L to 54.34 +/- 24.26 ng/L in the treated group (t= -2.73, P = 0.006), and from 16.15 +/- 24.40 ng/L to 40.61 +/- 81.54 ng/L in the control group (t = -1.72, P = 0.086), but the difference between groups was statistical insignificant (t= -1.120, P = 0.263). As for levels of FSH and LH, their decrements in the control group (13.16 +/- 11.29 mlU/mL and 10.37 +/- 9.21 mlU/mL) were larger than those in the treated group (4.92 +/- 4.26 mlU/mL and 0.17 +/- 2.42 mlU/mL), respectively (t = - 2.49, P = 0.013; t = - 2.38, P = 0.017).

CONCLUSIONChinese medicinal massage manipulation could improve the Kupperman index of all the 13 symptoms in women with climacteric syndrome, and increase the E2 level in serum.

Adult ; Estradiol ; blood ; Estrogens, Conjugated (USP) ; therapeutic use ; Female ; Follicle Stimulating Hormone ; blood ; Humans ; Luteinizing Hormone ; blood ; Massage ; Menopause ; Middle Aged

BACKGROUNDMenopausal hormone therapy (MHT) has been proven to have beneficial effects on several components of metabolic syndrome. However, the effects vary according to different regimens, dosages, and duration of MHT. The aim of the study was to evaluate the effect of standard-dose 0.625 mg conjugated equine estrogen (CEE) and half-dose 0.3 mg CEE daily with different progestogens in a continuous sequential regimen on postmenopausal metabolic parameters in generally healthy postmenopausal women.

METHODSA prospective, open-label, randomized controlled clinical trial was conducted between February 2014 and December 2015. Totally 123 Chinese postmenopausal women with climacteric symptoms were included in this study and were randomly assigned to three groups: Group A received CEE 0.3 mg/micronized progesterone (MP) 100 mg daily; Group B received CEE 0.625 mg/MP 100 mg daily; and Group C received CEE 0.625 mg/dydrogesterone 10 mg daily. Drugs were given in a continuous sequential pattern. The duration of treatment was 12 months. Clinical, anthropometrical, and metabolic variables were measured. Data were analyzed according to intention-to-treat analysis, using Student's t-test and analysis of variance.

RESULTSA total of 107 participants completed the 12-month follow-up and were included in the data analysis. At 12 months of treatment, high-density lipoprotein cholesterol and apolipoprotein A significantly increased, and low-density lipoprotein cholesterol, fasting glucose, and glycosylated hemoglobin significantly decreased in Groups B and C, compared with baseline (all P < 0.05). Among the three groups, only Group C showed significantly increased triglycerides compared with baseline (1.61 ± 0.80 mmol/L vs. 1.21 ± 0.52 mmol/L, P = 0.026). Each group showed a neutral effect on total cholesterol, lipoprotein A, apolipoprotein B, and fasting insulin levels. No cardiovascular and venous thromboembolic events occurred in the three groups.

CONCLUSIONSAmong Chinese postmenopausal women, half-dose CEE was not sufficient to induce a favorable lipid and carbohydrate profile compared with standard-dose CEE. Adding natural MP may counterbalance the TG-increasing effect of CEE.

TRIAL REGISTRATIONClinicalTrials.gov, NCT01698164; https://clinicaltrials.gov/ct2/show/NCT01698164?term=NCT01698164&rank=1.

Apolipoproteins B ; blood ; Blood Pressure ; drug effects ; Body Composition ; drug effects ; Dydrogesterone ; administration & dosage ; therapeutic use ; Estrogens, Conjugated (USP) ; administration & dosage ; therapeutic use ; Female ; Humans ; Insulin ; blood ; Lipoprotein(a) ; blood ; Metabolic Syndrome ; blood ; drug therapy ; Middle Aged ; Postmenopause ; Progesterone ; administration & dosage ; therapeutic use ; Triglycerides ; blood