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Pharmaceutical drug combination
Estradiol/medroxyprogesterone acetate (E2/MPA), sold under the brand names Indivina and Tridestra among others, is a combination product of estradiol, an estrogen, and medroxyprogesterone acetate, a progestogen, which is used in menopausal hormone therapy for the treatment of menopausal symptoms.[1] It is taken by mouth.
Results of the Women's Health Initiative (WHI) menopausal hormone therapy randomized controlled trials
Clinical outcome
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Hypothesized effect on risk
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Estrogen and progestogen (CEsTooltip conjugated estrogens 0.625 mg/day p.o. + MPATooltip medroxyprogesterone acetate 2.5 mg/day p.o.) (n = 16,608, with uterus, 5.2–5.6 years follow up)
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Estrogen alone (CEsTooltip Conjugated estrogens 0.625 mg/day p.o.) (n = 10,739, no uterus, 6.8–7.1 years follow up)
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HRTooltip Hazard ratio
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95% CITooltip Confidence interval
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ARTooltip Attributable risk
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HRTooltip Hazard ratio
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95% CITooltip Confidence interval
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ARTooltip Attributable risk
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Coronary heart disease
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Decreased
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1.24
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1.00–1.54
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+6 / 10,000 PYs
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0.95
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0.79–1.15
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−3 / 10,000 PYs
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Stroke
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Decreased
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1.31
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1.02–1.68
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+8 / 10,000 PYs
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1.37
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1.09–1.73
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+12 / 10,000 PYs
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Pulmonary embolism
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Increased
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2.13
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1.45–3.11
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+10 / 10,000 PYs
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1.37
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0.90–2.07
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+4 / 10,000 PYs
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Venous thromboembolism
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Increased
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2.06
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1.57–2.70
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+18 / 10,000 PYs
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1.32
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0.99–1.75
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+8 / 10,000 PYs
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Breast cancer
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Increased
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1.24
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1.02–1.50
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+8 / 10,000 PYs
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0.80
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0.62–1.04
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−6 / 10,000 PYs
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Colorectal cancer
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Decreased
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0.56
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0.38–0.81
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−7 / 10,000 PYs
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1.08
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0.75–1.55
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+1 / 10,000 PYs
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Endometrial cancer
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–
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0.81
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0.48–1.36
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−1 / 10,000 PYs
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–
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–
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–
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Hip fractures
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Decreased
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0.67
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0.47–0.96
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−5 / 10,000 PYs
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0.65
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0.45–0.94
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−7 / 10,000 PYs
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Total fractures
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Decreased
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0.76
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0.69–0.83
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−47 / 10,000 PYs
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0.71
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0.64–0.80
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−53 / 10,000 PYs
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Total mortality
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Decreased
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0.98
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0.82–1.18
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−1 / 10,000 PYs
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1.04
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0.91–1.12
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+3 / 10,000 PYs
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Global index
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–
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1.15
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1.03–1.28
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+19 / 10,000 PYs
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1.01
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1.09–1.12
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+2 / 10,000 PYs
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Diabetes
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–
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0.79
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0.67–0.93
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0.88
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0.77–1.01
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Gallbladder disease
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Increased
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1.59
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1.28–1.97
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1.67
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1.35–2.06
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Stress incontinence
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–
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1.87
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1.61–2.18
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2.15
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1.77–2.82
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Urge incontinence
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–
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1.15
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0.99–1.34
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1.32
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1.10–1.58
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Peripheral artery disease
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–
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0.89
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0.63–1.25
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1.32
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0.99–1.77
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Probable dementia
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Decreased
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2.05
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1.21–3.48
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1.49
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0.83–2.66
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Abbreviations: CEs = conjugated estrogens. MPA = medroxyprogesterone acetate. p.o. = per oral. HR = hazard ratio. AR = attributable risk. PYs = person–years. CI = confidence interval. Notes: Sample sizes (n) include placebo recipients, which were about half of patients. "Global index" is defined for each woman as the time to earliest diagnosis for coronary heart disease, stroke, pulmonary embolism, breast cancer, colorectal cancer, endometrial cancer (estrogen plus progestogen group only), hip fractures, and death from other causes. Sources: See template.
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Notes and references
[edit]
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Estrogens | ERTooltip Estrogen receptor agonists |
- Steroidal: Alfatradiol
- Certain androgens/anabolic steroids (e.g., testosterone, testosterone esters, methyltestosterone, metandienone, nandrolone esters) (via estrogenic metabolites)
- Certain progestins (e.g., norethisterone, noretynodrel, etynodiol diacetate, tibolone)
- Clomestrone
- Cloxestradiol acetate
- Conjugated estriol
- Conjugated estrogens
- Epiestriol
- Epimestrol
- Esterified estrogens
- Estetrol†
- Estradiol
- Estradiol esters (e.g., estradiol acetate, estradiol benzoate, estradiol cypionate, estradiol enanthate, estradiol undecylate, estradiol valerate, polyestradiol phosphate, estradiol ester mixtures (Climacteron))
- Estramustine phosphate
- Estriol
- Estriol esters (e.g., estriol succinate, polyestriol phosphate)
- Estrogenic substances
- Estrone
- Estrone esters
- Ethinylestradiol#
- Hydroxyestrone diacetate
- Mestranol
- Methylestradiol
- Moxestrol
- Nilestriol
- Prasterone (dehydroepiandrosterone; DHEA)
- Promestriene
- Quinestradol
- Quinestrol
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Progonadotropins | |
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Antiestrogens | ERTooltip Estrogen receptor antagonists (incl. SERMsTooltip selective estrogen receptor modulators/SERDsTooltip selective estrogen receptor downregulators) | |
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Aromatase inhibitors | |
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Antigonadotropins |
- Androgens/anabolic steroids (e.g., testosterone, testosterone esters, nandrolone esters, oxandrolone, fluoxymesterone)
- D2 receptor antagonists (prolactin releasers) (e.g., domperidone, metoclopramide, risperidone, haloperidol, chlorpromazine, sulpiride)
- GnRH agonists (e.g., leuprorelin, goserelin)
- GnRH antagonists (e.g., cetrorelix, elagolix)
- Progestogens (e.g., chlormadinone acetate, cyproterone acetate, gestonorone caproate, hydroxyprogesterone caproate, medroxyprogesterone acetate, megestrol acetate)
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Others | |
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ERTooltip Estrogen receptor | Agonists |
- Steroidal: 2-Hydroxyestradiol
- 2-Hydroxyestrone
- 3-Methyl-19-methyleneandrosta-3,5-dien-17β-ol
- 3α-Androstanediol
- 3α,5α-Dihydrolevonorgestrel
- 3β,5α-Dihydrolevonorgestrel
- 3α-Hydroxytibolone
- 3β-Hydroxytibolone
- 3β-Androstanediol
- 4-Androstenediol
- 4-Androstenedione
- 4-Fluoroestradiol
- 4-Hydroxyestradiol
- 4-Hydroxyestrone
- 4-Methoxyestradiol
- 4-Methoxyestrone
- 5-Androstenediol
- 7-Oxo-DHEA
- 7α-Hydroxy-DHEA
- 7α-Methylestradiol
- 7β-Hydroxyepiandrosterone
- 8,9-Dehydroestradiol
- 8,9-Dehydroestrone
- 8β-VE2
- 10β,17β-Dihydroxyestra-1,4-dien-3-one (DHED)
- 11β-Chloromethylestradiol
- 11β-Methoxyestradiol
- 15α-Hydroxyestradiol
- 16-Ketoestradiol
- 16-Ketoestrone
- 16α-Fluoroestradiol
- 16α-Hydroxy-DHEA
- 16α-Hydroxyestrone
- 16α-Iodoestradiol
- 16α-LE2
- 16β-Hydroxyestrone
- 16β,17α-Epiestriol (16β-hydroxy-17α-estradiol)
- 17α-Estradiol (alfatradiol)
- 17α-Dihydroequilenin
- 17α-Dihydroequilin
- 17α-Epiestriol (16α-hydroxy-17α-estradiol)
- 17α-Ethynyl-3α-androstanediol
- 17α-Ethynyl-3β-androstanediol
- 17β-Dihydroequilenin
- 17β-Dihydroequilin
- 17β-Methyl-17α-dihydroequilenin
- Abiraterone
- Abiraterone acetate
- Alestramustine
- Almestrone
- Anabolic steroids (e.g., testosterone and esters, methyltestosterone, metandienone (methandrostenolone), nandrolone and esters, many others; via estrogenic metabolites)
- Atrimustine
- Bolandiol
- Bolandiol dipropionate
- Butolame
- Clomestrone
- Cloxestradiol
- Conjugated estriol
- Conjugated estrogens
- Cyclodiol
- Cyclotriol
- DHEA
- DHEA-S
- ent-Estradiol
- Epiestriol (16β-epiestriol, 16β-hydroxy-17β-estradiol)
- Epimestrol
- Equilenin
- Equilin
- ERA-63 (ORG-37663)
- Esterified estrogens
- Estetrol
- Estradiol
- Estramustine
- Estramustine phosphate
- Estrapronicate
- Estrazinol
- Estriol
- Estrofurate
- Estrogenic substances
- Estromustine
- Estrone
- Etamestrol (eptamestrol)
- Ethinylandrostenediol
- Ethinylestradiol
- Ethinylestriol
- Ethylestradiol
- Etynodiol
- Etynodiol diacetate
- Hexolame
- Hippulin
- Hydroxyestrone diacetate
- Lynestrenol
- Lynestrenol phenylpropionate
- Mestranol
- Methylestradiol
- Moxestrol
- Mytatrienediol
- Nilestriol
- Norethisterone
- Noretynodrel
- Orestrate
- Pentolame
- Prodiame
- Prolame
- Promestriene
- RU-16117
- Quinestradol
- Quinestrol
- Tibolone
- Xenoestrogens: Anise-related (e.g., anethole, anol, dianethole, dianol, photoanethole)
- Chalconoids (e.g., isoliquiritigenin, phloretin, phlorizin (phloridzin), wedelolactone)
- Coumestans (e.g., coumestrol, psoralidin)
- Flavonoids (incl. 7,8-DHF, 8-prenylnaringenin, apigenin, baicalein, baicalin, biochanin A, calycosin, catechin, daidzein, daidzin, ECG, EGCG, epicatechin, equol, formononetin, glabrene, glabridin, genistein, genistin, glycitein, kaempferol, liquiritigenin, mirificin, myricetin, naringenin, penduletin, pinocembrin, prunetin, puerarin, quercetin, tectoridin, tectorigenin)
- Lavender oil
- Lignans (e.g., enterodiol, enterolactone, nyasol (cis-hinokiresinol))
- Metalloestrogens (e.g., cadmium)
- Pesticides (e.g., alternariol, dieldrin, endosulfan, fenarimol, HPTE, methiocarb, methoxychlor, triclocarban, triclosan)
- Phytosteroids (e.g., digitoxin (digitalis), diosgenin, guggulsterone)
- Phytosterols (e.g., β-sitosterol, campesterol, stigmasterol)
- Resorcylic acid lactones (e.g., zearalanone, α-zearalenol, β-zearalenol, zearalenone, zeranol (α-zearalanol), taleranol (teranol, β-zearalanol))
- Steroid-like (e.g., deoxymiroestrol, miroestrol)
- Stilbenoids (e.g., resveratrol, rhaponticin)
- Synthetic xenoestrogens (e.g., alkylphenols, bisphenols (e.g., BPA, BPF, BPS), DDT, parabens, PBBs, PHBA, phthalates, PCBs)
- Others (e.g., agnuside, rotundifuran)
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Mixed (SERMsTooltip Selective estrogen receptor modulators) | |
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Antagonists |
- Coregulator-binding modulators: ERX-11
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GPERTooltip G protein-coupled estrogen receptor | Agonists | |
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Antagonists | |
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Unknown | |
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PRTooltip Progesterone receptor | Agonists |
- Testosterone derivatives: Progestins: 6,6-Difluoronorethisterone
- 6,6-Difluoronorethisterone acetate
- 17α-Allyl-19-nortestosterone
- Allylestrenol
- Altrenogest
- Chloroethynylnorgestrel
- Cingestol
- Danazol
- Desogestrel
- Dienogest
- Ethinylandrostenediol
- Ethisterone
- Ethynerone
- Etonogestrel
- Etynodiol
- Etynodiol diacetate
- Gestodene
- Gestrinone
- Levonorgestrel
- Levonorgestrel esters (e.g., levonorgestrel butanoate)
- Lynestrenol
- Lynestrenol phenylpropionate
- Metynodiol
- Metynodiol diacetate
- Norelgestromin
- Norethisterone (norethindrone)
- Norethisterone esters (e.g., norethisterone acetate, norethisterone enanthate)
- Noretynodrel
- Norgesterone
- Norgestimate
- Norgestrel
- Norgestrienone
- Norvinisterone
- Oxendolone
- Quingestanol
- Quingestanol acetate
- Tibolone
- Tigestol
- Tosagestin; Anabolic–androgenic steroids: 11β-Methyl-19-nortestosterone
- 11β-Methyl-19-nortestosterone dodecylcarbonate
- 19-Nor-5-androstenediol
- 19-Nor-5-androstenedione
- 19-Nordehydroepiandrosterone
- Bolandiol
- Bolandiol dipropionate
- Bolandione
- Dimethisterone
- Dienedione
- Dienolone
- Dimethandrolone
- Dimethandrolone buciclate
- Dimethandrolone dodecylcarbonate
- Dimethandrolone undecanoate
- Dimethyldienolone
- Dimethyltrienolone
- Ethyldienolone
- Ethylestrenol (ethylnandrol)
- Methyldienolone
- Metribolone (R-1881)
- Methoxydienone (methoxygonadiene)
- Mibolerone
- Nandrolone
- Nandrolone esters (e.g., nandrolone decanoate, nandrolone phenylpropionate)
- Norethandrolone
- Normethandrone (methylestrenolone, normethandrolone, normethisterone)
- RU-2309
- Tetrahydrogestrinone
- Trenbolone (trienolone)
- Trenbolone esters (e.g., trenbolone acetate, trenbolone enanthate)
- Trendione
- Trestolone
- Trestolone acetate
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Mixed (SPRMsTooltip Selective progesterone receptor modulators) | |
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Antagonists | |
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mPRTooltip Membrane progesterone receptor (PAQRTooltip Progestin and adipoQ receptor) | |
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