Psychological effects of tibolone and sequential estrogen-progestogen therapy in perimenopausal women

Objective To investigate changes in psychological symptoms before and after continuous tibolone treatment and sequential estrogen-progestogen therapy in perimenopausal women. Methods In this prospective, randomized, controlled study, perimenopausal women were randomly allocated to treatment with either tibolone 2.5 mg/day for 28 days (n = 28), or 0.625 mg conjugated equine estrogens (CEE) for 25 days plus 5 mg medroxyprogesterone acetate (MPA) daily on days 16-25 (n = 3 3). The differences in Beck's depression scores and serum lipid profiles before and after 1 year of treatment with both regimens were compared. Results Both groups were similar with respect to demographic characteristics. The differences in Beck's depression scores before and after treatment were statistically significant in the tibolone group (21.3 vs 17.1, p = 0.038) and also in the group receiving standard sequential estrogen-progestogen treatment (15.7 vs. 13.0, p = 0.040). In the sequential estrogen-progesterone group, a statistically significant increase was measured in high-density lipoprotein (HDL)-cholesterol levels after treatment (49.1 vs. 56.8 mg/dl, p = 0.023). Conclusion Tibolone is as effective as sequential estrogen-progesterone therapy in alleviating the psychological symptoms of the perimenopause. In addition, CEE + MPA induces favorable changes in HDL-cholesterol.