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Respiratory Insufficiency in Postmenopausal Women^*

Sustained Improvement of Gas Exchange With Short-term Medroxyprogesterone Acetate

* From the Departments of Pulmonary Diseases (Dr. Saaresranta), Obstetrics and Gynecology (Dr. Polo-Kantola), and Clinical Chemistry (Dr. Irjala), Turku University Hospital, Turku, Finland; and the Departments of Biostatistics (Mr. Helenius) and Physiology (Dr. Polo), Turku University, Turku, Finland. Supported by grants from The Finnish Anti-Tuberculosis Association Foundation, The Väinö and Laina Kivi Foundation, and The Turku University Foundation. Medication supply from the drug company Orion, Espoo, Finland.

Study objectives: The degree and duration of respiratory stimulation of medroxyprogesterone acetate (MPA) in postmenopausal women.

Design: A placebo-controlled single-blind trial.

Setting: University hospital in Turku, Finland.

Patients: Fourteen postmenopausal women with permanent or previous episodic hypercapnic or hypoxemic respiratory failure.

Interventions: A 12-week trial including 14-day treatment periods with placebo and MPA (60 mg daily) and a 6-week follow-up.

Results: Thirteen of 14 patients completed the trial. The mean (± SD) PaCO₂ at baseline was 42.8 ± 4.5 mm Hg and the mean PaO₂ was 71.2 ± 9.0 mm Hg. The average reduction of PaCO₂ was 6.3 mm Hg (14.7%, p < 0.001) on MPA and 3.0 mm Hg (6.1%, p = 0.001) after a 3-week washout. At 6 weeks after MPA, the PaCO₂ had returned to baseline. The mean changes in PaO₂ (+6.0 ± 18.0 mm Hg on MPA and +3.8 ± 22.5 mm Hg after a 3-week washout) were not significant. The PaO₂/PaCO₂ ratio increased, and bicarbonate and base excess decreased (p < 0.001) on MPA but not during washout. The systolic BP did not change on MPA but decreased on average 14.8 ± 15.0 mm Hg (p = 0.016) after a 3-week washout. The diastolic BP remained unchanged.

Conclusions: Our results suggest that postmenopausal women with chronic respiratory insufficiency consistently improve on MPA at a dose of 60 mg daily for 14 days. Lower PaCO₂ is sustained for at least 3 weeks after cessation of MPA. The sustained effects in gas exchange and favorable after-effects in BP warrant further studies into the therapeutic efficacy and possible benefits of MPA pulse therapy.

Key Words: COPD • hypercapnia • hypoxemia • medroxyprogesterone acetate • menopause • respiratory stimulant • sustained effect • women

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