Mirena and Estrogen for Control of Perimenopause Symptoms and Ovulation Suppression

This study has been completed.
Information provided by (Responsible Party):
University of Colorado, Denver
ClinicalTrials.gov Identifier:
First received: June 4, 2012
Last updated: March 12, 2015
Last verified: March 2015

Hormonal treatment of perimenopausal women has frequently utilized oral contraceptive pills (OCPs). Because of their ability to suppress ovulation and establish cycle control, OCPs have become a popular option, and one that is FDA approved for use until menopause. However, use of OCPs in women in their 40's and 50's carries significant cardiovascular risks. Venous thromboembolism risk is 3-6 fold greater in OCP users, and the risk of myocardial infarction (MI) is approximately doubled in OCP users over the age of 40. This occurs at an age where the background population risk of MI begins to increase, such that the absolute number of cases rises substantially. Women with additional risk factors for cardiovascular disease have a much greater risk for MI (6-40-fold) in association with OCPs. There are also large subgroups of midlife women who are not candidates for OCP use, such a smokers and migraineurs. Moreover, the trend towards lower estrogen dosing with OCPs containing 20 micrograms of ethinyl estradiol has not led to a detectable decrease in thromboembolic risk.

Because of their increased potential risks, it is appropriate to seek alternatives to OCPs and to explore lower doses of hormones to relieve perimenopausal symptoms that occur prior to a woman's final menses. Recent evidence indicates that the hypothalamic-pituitary axis of reproductively aging women is more susceptible to suppression by sex steroids that previously believed. It is possible that hormone doses as low as 50 micrograms of transdermal estradiol (TDE) can suppress the hypothalamic-pituitary axis of midlife women. It is also tempting to speculate that the low but measurable circulating doses of levonorgestrel that are present when a woman uses the Mirena intrauterine system (IUS) can contribute to or even independently suppress the hypothalamic-pituitary axis, and reduce the hormonal fluctuations that result in worsening of perimenopausal symptoms. The combination of low dose TDE plus Mirena may therefore confer superior symptom control as well as contraceptive effectiveness, at far less risk.

Condition Intervention
Menopausal and Other Perimenopausal Disorders
Drug: Mirena
Drug: Estradiol
Drug: Placebo Gel

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Pharmacokinetics Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Effectiveness of Perimenopausal Hormone Therapy in Suppression of Ovulation, Stabilization of Reproductive Hormones and Symptom Control

Resource links provided by NLM:

Further study details as provided by University of Colorado, Denver:

Primary Outcome Measures:
  • Ovulation [ Time Frame: Days 90-140 (daily) ] [ Designated as safety issue: No ]
    Daily urinary monitoring for progesterone metabolite excretion, pregnanediol glucuronide

Secondary Outcome Measures:
  • Hot Flashes [ Time Frame: Day 0, 90 and 140 ] [ Designated as safety issue: No ]
    Ten item scale measuring degree to which hot flashes interfere with 9 daily activities (work, social, leisure, sleep, mood, concentration, relations, sexuality, enjoyment of life, overall quality of life) over the prior week, each scored on a 10 point Likert scale, rate during previous week.

  • Sleep [ Time Frame: Day 0, 90, and 140 ] [ Designated as safety issue: No ]
    A short questionnaire designed to measure general sleep disturbances over previous month will be used. This is designed to assess self-reported sleep quality (sleep wake patterns, duration of sleep, sleep latency , impact of poor sleep on daytime functioning, assesses specific problems contributing to poor sleep, including pain, urination, breathing difficulty, snoring, dreams, temperature. In addition, a 9-item self-report scale assessing fatigue over the past week will be used.

  • Depression [ Time Frame: Day 0, 90, 140 ] [ Designated as safety issue: No ]
    A 20-item scale with 4-level responses indicating frequency of symptoms over past week will be used to assess symptoms.

Enrollment: 39
Study Start Date: April 2012
Study Completion Date: June 2014
Primary Completion Date: June 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Mirena + Estradiol Gel
Subjects will be assigned to use of Estradiol gel for use with Mirena.
Drug: Mirena
Mirena (levonorgestrel-releasing intrauterine system), 52 mg (20 mcg/day), 5 year duration (study duration 6 months).
Other Name: IUD
Drug: Estradiol
Topical, .06%, Applied once daily for 50 days.
Other Name: TDE
Placebo Comparator: Mirena + Placebo Gel
Subjects will be assigned to use of placebo gel for use with Mirena.
Drug: Mirena
Mirena (levonorgestrel-releasing intrauterine system), 52 mg (20 mcg/day), 5 year duration (study duration 6 months).
Other Name: IUD
Drug: Placebo Gel
Topical Gel, Applied once daily for 50 days, Placebo comparator.
Other Name: placebo

Detailed Description:

The Specific Aims of the present proposal are therefore as follows:

Aim 1: To test the hypothesis that low dose estrogen therapy in concert with the low doses of levonorgestrel that circulate when Mirena is used will suppress ovulation in perimenopausal women.

Aim 2: To examine ovulation rates and symptom control with Mirena alone, and to assess the tolerability of combined estrogen therapy plus the Mirena IUS as a treatment option for symptomatic perimenopausal women.

The proposed pilot study is designed to test the feasibility and tolerability of the proposed regimens: Mirena alone or Mirena plus low-dose TDE in treating symptoms in perimenopausal women and to provide the preliminary data for a larger, comparative effectiveness study of optimal symptom control and provision of long term contraception for midlife women within 5 years of their final menstrual period.


Ages Eligible for Study:   40 Years to 52 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age 40-52
  • History of regular menstrual cycles every 20-35 days in mid-reproductive life (20-35 years of age)
  • At least 1 period within the past 3 months
  • BMI less than 35 kg/m2
  • Presence of at least one of the following perimenopausal symptoms:

    1. Hot flashes (vasomotor symptoms)
    2. Cyclical headache, bloating or adverse mood
    3. Self-reported poor quality of sleep

Exclusion Criteria:

  • Age < 40 years
  • Hysterectomy or bilateral oophorectomy
  • Cigarette smoking
  • Signs or symptoms of restless leg syndrome or sleep apnea
  • Any chronic renal or hepatic disease that might interfere with excretion of gonadotropins or sex steroids
  • Moderate/vigorous aerobic exercise > 4 hours per week
  • Inability to read/write English
  • Pregnant Women
  • Prisoners
  • Decisionally challenged subjects
  • Any medical condition that makes use of Topical estradiol or Mirena contraindicated.
  • Sex hormone use within the past 30 days
  • History of cancer, blood clots or blood clotting disorder
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01613131

United States, Colorado
University of Colorado
Aurora, Colorado, United States, 80045
Sponsors and Collaborators
University of Colorado, Denver
Principal Investigator: Nanette Santoro, MD University of Colorado, Denver
  More Information

No publications provided

Responsible Party: University of Colorado, Denver
ClinicalTrials.gov Identifier: NCT01613131     History of Changes
Other Study ID Numbers: 11-1711
Study First Received: June 4, 2012
Last Updated: March 12, 2015
Health Authority: United States: Institutional Review Board

Additional relevant MeSH terms:
Estradiol 17 beta-cypionate
Estradiol 3-benzoate
Estradiol valerate
Polyestradiol phosphate
Contraceptive Agents
Contraceptive Agents, Female
Contraceptives, Oral
Contraceptives, Oral, Synthetic
Hormones, Hormone Substitutes, and Hormone Antagonists
Pharmacologic Actions
Physiological Effects of Drugs
Reproductive Control Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on November 27, 2015