From the FDA Drug Label
Risk factors for arterial vascular disease (for example, hypertension, diabetes mellitus, tobacco use, hypercholesterolemia, and obesity) and/or venous thromboembolism (for example, personal history or family history of venous thromboembolism [VTE], obesity, and systemic lupus erythematosus) should be managed appropriately.
The FDA drug label does not provide direct guidance on discontinuing progesterone therapy after 20 years of treatment for Abnormal Uterine Bleeding (AUB) in a 52-year-old female. However, considering the potential risks associated with long-term hormone therapy, such as venous thromboembolism and arterial vascular disease, it is essential to weigh the benefits and risks of continuing therapy.
- The labels mention the importance of managing risk factors for arterial vascular disease and venous thromboembolism.
- They also discuss the increased risk of stroke, coronary heart disease, and breast cancer associated with estrogen plus progestin therapy. Given the lack of direct guidance on discontinuation, a conservative clinical decision would be to consider alternative treatment options or to closely monitor the patient for potential adverse effects, taking into account her individual risk factors and medical history 1, 1.
From the Research
A 52-year-old female who has been taking progesterone (progestin) 100mg daily for 20 years to treat Abnormal Uterine Bleeding (AUB) should consider discontinuing the medication, but only after consulting with her healthcare provider. At age 52, she may be approaching or experiencing menopause, when natural hormonal changes often resolve AUB without medication. To discontinue safely, she should work with her provider to gradually taper the dose rather than stopping abruptly, which could trigger withdrawal bleeding or symptom recurrence. Her provider should evaluate her current bleeding patterns, menopausal status, and overall health before making this decision. If she's already in menopause (defined as 12 consecutive months without menstruation), the continued use of progestin may no longer be necessary, as suggested by the most recent study on hormone replacement therapy 2. However, if she's still experiencing abnormal bleeding, her provider might recommend continuing treatment or exploring alternative options. The long-term use of progestins carries potential risks including mood changes, breast tenderness, and possible cardiovascular effects, making periodic reassessment of this long-term therapy important for her overall health, as highlighted in a study on the role of progestogen in hormone therapy for postmenopausal women 3.
Some key points to consider in this decision include:
- The primary role of progestogen in postmenopausal hormone therapy is endometrial protection, as noted in a study on the role of progestogen in hormone therapy for postmenopausal women 3
- The type of progestogen used can impact the risk of cardiovascular and breast cancer, with some progestogens being safer than others, as discussed in a study on micronized progesterone, progestins, and menopause hormone therapy 4
- Non-oral delivery routes for progestogens may be preferred due to a lesser stimulation of liver proteins and a neutral metabolic profile, as suggested in a study on new hormonal therapies and regimens in the postmenopause 5
- The benefits and risks of hormone replacement therapy should be carefully considered, with the most recent recommendations suggesting that HRT can be effective in improving menopausal symptoms, but also carries potential risks, as discussed in a review of current recommendations for HRT use in menopausal women 2.
Ultimately, the decision to discontinue progesterone therapy should be made on an individual basis, taking into account the woman's specific health needs and medical history, and in consultation with her healthcare provider.