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Menopausal SymptomsPhase 3NCT05586724

Micronized Progesterone Versus Norethisterone Acetate in Combination With Estrogen as Menopausal Hormone Therapy

A Phase 3 study testing Micronized progesterone in continuous combination with oral estrogen and Norethisterone acetate in continuous combination with oral estrogen in people with Menopausal Symptoms, run by Angelica Lindén Hirschberg at 1 site in Sweden.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

About one third of all women during menopausal transition have significant climacteric symptoms with considerable impact on quality of life. Meta-analysis has shown a beneficial risk profile with menopausal hormone therapy (MHT) for women 50 to 60 years. Read more about this study

Who is it for?
Ages 45 to 60 years, women only
Conditions the study is for
Menopausal Symptoms
What is being tested?
Micronized progesterone in continuous combination with oral estrogen and Norethisterone acetate in continuous combination with oral estrogen
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
520 participants
Where
1 siteSweden
Study dates
15 Mar 2022to Dec 2027
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 45 to 60 years
  • Women only
  • No healthy volunteers
  • Adult

Who may be able to join

  • Healthy and naturally postmenopausal women (more than one year since last menstruation or FSH > 40 IE/L) with climacteric symptoms (sweating, hot flush and/or sleep problems) that adversely affect the quality of life
  • Age 45-60 years
  • BMI > 19 kg/m2 and ≤ 32 kg/m2
  • Intact uterus
  • In case of previous MHT use, washout 8 weeks for oral MHT and 4 weeks for transdermal MHT or local estrogen treatment before screening
  • Written informed consent

Who cannot join

  • Previous history or risk factors for breast cancer, breast cancer in situ or abnormal mammogram at baseline as assessed clinically by a radiology expert
  • Previous history or risk factors for endometrial cancer or hyperplasia or abnormal/proliferative endometrial biopsy at baseline
  • Vaginal bleeding
  • Any concomitant medical treatment except for well-controlled hypertension, non-insulin treated type 2 diabetes, asthma and hypothyroidism
  • History or presence of or risk factor for cardiovascular disease including thromboembolic disorder or cerebrovascular disease
  • History or presence of liver and gallbladder disease, familial hyperlipidemia, epilepsy or classical migraine with aura
Show all 12Show fewer
  • History or presence of clinically significant depression or other psychiatric disorder that might in anyway compromise the performance of the trial or undermine its scientific validity
  • Porphyria, Systemic lupus erythematosus and otosclerosis
  • Current use of MHT or local estrogen treatment
  • Alcohol and/or drug abuse
  • Clinically significant findings on physical and/or gynecological examination at baseline
  • Hypersensitivity to any of the study treatments

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Sweden1 site, 1 recruiting
  • Karolinska University Hospital

    Stockholm, 171 76

    Angelica L Hirschberg, +46702559924, angelica.linden-hirschberg@regionstockholm.se

    Helena Kopp Kallner, MD, PhD

    Recruiting

Other trials in Sweden

About this study

Official title: Safety of Oral Micronized Progesterone Versus Norethisterone Acetate in Continuous Combination With Oral Estrogen as Menopausal Hormone Therapy - a Double-blind Randomized Study- PROBES Study (Progesterone Breast Endometrial Safety Study)

About one third of all women during menopausal transition have significant climacteric symptoms with considerable impact on quality of life. Meta-analysis has shown a beneficial risk profile with menopausal hormone therapy (MHT) for women 50 to 60 years. Still, there is a great need to find safe MHT able to control excessive endometrial stimulation by estrogen without stimulatory effects on the breast by the combination of estrogen/progestogen. Recent observational studies indicate a lower risk for breast cancer using micronized progesterone (mP) combined with estrogen but increased risk of endometrial cancer than by standard MHT. In a randomized trial, the balance between benefits and risks of mP vs. progestogens (norethisterone (NETA)) in combination with estrogen will be explored. For apparent reasons, long-term largescale clinical trials with endometrial and breast cancer as the primary endpoints, are not feasible. However, much knowledge can be obtained using relevant surrogate markers. Mammographic breast density is a strong risk factor for breast cancer, and endometrial hyperplasia is a strong risk factor for endometrial cancer. The primary objective is to compare the effects of one year treatment with mP versus progestogen, in combination with estradiol on mammographic breast density. Furthermore, to evaluate the effect of one year treatment with mP in continuous combination with estradiol on endometrial pathology (hyperplasia and cancer).

Read the detailed description

Postmenopausal women with climacteric symptoms will be randomized (1:1) to double blind treatment with oral mP or NETA in combination with oral estradiol. For the breast part, a power analysis revealed that 91 women/group would be sufficient to detect a significant difference in mammographic breast density between the groups at the 5%-level (two-sided) with 80% power. Considering the estimated rate of discontinuation and incomplete data, the target sample for the breast part is 260 patients. For the endometrial part, it is estimated that two or less women with serious adverse endometrial outcomes would result in an annual incidence of endometrial pathology of 0.67% or less with an upper bound of the one-sided 95% CI of 2.08% or less. Considering the estimated rate of discontinuation and incomplete data in the mP + estradiol group, the target sample for this part of the study is 390 patients. The total number of patients in part 1 and 2 will be 520.

Mammography at baseline and after 12 months of treatment will be assessed by independent radiologists at the Karolinska University Hospital blinded to treatment. In addition to visual judgment, a computer based quantitative assessment will be performed. All mammograms will be anonymous so that the operator will be unaware of the patient's identity and type of treatment. Percentage change in mammographic density will be evaluated and compared between the groups.

Endometrial biopsies at baseline and after 12 months of treatment will be evaluated by two independent pathologists at the Karolinska University Hospital for the incidence of endometrial pathology (hyperplasia or cancer) in the mP + estradiol group. Furthermore, immunostaining of the proliferation marker Ki-67, and other markers related to proliferation and apoptosis will be analyzed and compared between groups.

Different validated self-assessment questionnaires will be used for screening of mood disorders like depression and anxiety, as well as quality of life and menopausal symptoms. The Patient Health Questionnaire (PHQ-9) is a tool for screening, diagnosing, and measuring the severity of depression. The Hospital Anxiety and Depression Scale (HADS) is an instrument for detecting states of depression and anxiety in the setting of a hospital or medical outpatient clinic. Health related quality of life is measured using the Psychological General Well-Being Index (PGWB). The Women's Health Questionnaire (WHQ) measures menopausal symptoms. The change in scores will be compared between the groups.

Blood lipid profile, serum hormones, growth and metabolic factors, and coagulation factors will be analyzed.

The gut- and vaginal microbiome will be characterized and compared between groups.

Being tested
Micronized progesterone in continuous combination with oral estrogen, Norethisterone acetate in continuous combination with oral estrogen
Keywords
Menopausal hormone therapy, Climacteric symptoms, Progesterone, Progestogens, Breast safety, Endometrial safety

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Micronized progesterone in continuous combination with oral estrogenDrug

    Capsule 100 mg mP (Utrogestan®) orally per day in continuous combination with 1 mg encapsulated estradiol (Estrofem®)

  • Norethisterone acetate in continuous combination with oral estrogenDrug

    Capsule 0.5 mg NETA/ 1 mg estradiol (Activelle®) orally per day (encapsulated and identical to Estrofem® and one matched placebo to Utrogestan

Study groups in NCT05586724
Study groupRoleWhat they receive
Micronized progesterone in continuous combination with oral estrogenActive comparatorCapsule 100 mg mP (Utrogestan®) orally per day in continuous combination with 1 mg encapsulated estradiol (Estrofem®)
Receives: Drug: Micronized progesterone in continuous combination with oral estrogen
Norethisterone acetate in continuous combination with oral estrogenActive comparatorCapsule 0.5 mg NETA/ 1 mg estradiol (Activelle®) orally per day (encapsulated and identical to Estrofem® and one matched placebo to Utrogestan.
Receives: Drug: Norethisterone acetate in continuous combination with oral estrogen

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Mammographic breast density

    Percentage change in mammographic density

    Measured: At baseline and 12 months treatment

  2. Endometrial pathology

    The incidence of endometrial pathology (hyperplasia or cancer)

    Measured: At baseline and 12 months treatment

Secondary outcomes (11)
  1. Breast cell proliferation

    Percentage change in breast cell proliferation (proliferation marker Ki-67)

    Measured: At baseline and 12 months treatment

  2. Endometrial histology and cell proliferation

    Percentage change in endometrial cell proliferation (histology classification and proliferation marker Ki-67)

    Measured: At baseline and 12 months treatment

  3. Endometrial thickness

    Change in endometrial thickness by ultrasound

    Measured: At baseline and 12 months treatment

  4. Bleeding pattern

    Bleeding patterns registered in diary (number of days of bleedings)

    Measured: 3, 6, 9 and 12 months

  5. Gene and protein expression of growth factors and apoptosis markers in breast and endometrial tissue

    Change in gene and protein expression (proliferation and apoptosis markers)

    Measured: At baseline and 12 months treatment

  6. Depression (PHQ-9)

    Change in score of PHQ-9: A 4-point scale where a larger value reflects more depression.

    Measured: At baseline and 12 months treatment

  7. Anxiety (HADS)

    Change in score of HADS: A 4-point scale where a larger value reflects more anxiety.

    Measured: At baseline and 12 months treatment

  8. Quality of life (PGWB)

    Change in score of PGWBI, where a where a higher score reflects more well-being.

    Measured: At baseline and 12 months treatment

  9. Menopausal symptoms (WHQ)

    WHQ: A 4-point scale where a larger value reflects less menopausal symptoms.

    Measured: At baseline and 12 months treatment

  10. Serum levels of hormones, growth factors, lipids and coagulation factors.

    Change in serum levels of these markers

    Measured: At baseline and 12 months treatment

  11. Gut- and vaginal microbiome

    Change in microbiome diversity and relative abundance of different microbial species.

    Measured: At baseline and 12 months treatment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Oct 2022
  2. Study start15 Mar 2022
  3. Primary completionSep 2026 (estimated)
  4. Study completionDec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
520 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05586724
Sponsor's protocol ID
2021-001624-17
Status last verified
Jun 2024
First submitted
9 Oct 2022
Last updated
4 Jun 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Deidentified data will be available to external researchers upon reasonable request after publication of the results and approval of the study management team.

Publications

  • Bofill Rodriguez M, Yong LN, Mirkov S, Bekos C, Lethaby A, Farquhar C. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2026 Sep 4;9(9):CD004143. doi: 10.1002/14651858.CD004143.pub7.

    PubMed 42695385
  • Bofill Rodriguez M, Yong LN, Mirkov S, Bekos C, Lethaby A, Farquhar C. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2025 Nov 27;11(11):CD004143. doi: 10.1002/14651858.CD004143.pub6.

    PubMed 41307293
  • Lundell C, Stergiopoulos N, Blomberg L, Ujvari D, Schuppe-Koistinen I, Kopp-Kallner H, Iliadis SI, Skalkidou A, Hirschberg AL. Breast and endometrial safety of micronised progesterone versus norethisterone acetate in menopausal hormone therapy (PROBES): study protocol of a double-blind randomised controlled trial. BMJ Open. 2024 Oct 23;14(10):e082749. doi: 10.1136/bmjopen-2023-082749.

    PubMed 39448218

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Micronized progesterone in continuous combination with oral estrogen and Norethisterone acetate in continuous combination with oral estrogen in people with Menopausal Symptoms, run by Angelica Lindén Hirschberg at 1 site in Sweden.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 4 Jun 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Angelica L Hirschberg, MD, PhD (+46 70 255 99 24, angelica.linden-hirschberg@regionstockholm.se), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Mammographic breast density (time frame: At baseline and 12 months treatment). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05586724, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Jun 2024.

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