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Postmenopausal women taking hormone therapy prefer not to bleed. Regimens that combine estrogen and a progestin do not cause monthly withdrawal bleeding but often cause breakthrough bleeding. These authors from Amsterdam randomized 194 postmenopausal women to 2.5 mg, 5 mg, 10 mg, or 15 mg of dydrogesterone combined with 2 mg of micronized 17-beta-estradiol for 168 days and measured dihydrodydrogesterone levels; 152 women completed the study.
Both hormone concentrations varied widely among individuals but varied little in each individual. The four groups had similar numbers of women who bled and numbers of bleeding days. Women who dropped out of the study had significantly longer bleeding episodes. Although cigarette smoking decreased estradi…