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. 2016 Oct 12;2016(10):CD008536. doi: 10.1002/14651858.CD008536.pub3

Ziaei 2010.

Methods Randomised controlled trial
Participants 150 healthy postmenopausal women (mean age at menopause: 49 years), 45 to 60 years of age (mean age 52 years), whose last menstrual period was more than a year ago with plasma 17β‐oestradiol < 35 pg/mL
Interventions
  • Tibolone 2.5 mg plus a Cal + vit D tablet (500 mg/200 IU)

  • 0.625 mg conjugated equine oestrogen and 2.5 mg medroxyprogesterone acetate (CEE/MPA) plus 1 Cal+D tablet (500 mg/200 IU)


Administered for 6 months
Outcomes Vaginal bleeding (requiring > 1 sanitary napkin per day), vaginal spotting (requiring just 1 sanitary napkin per day), vaginal dryness, vasomotor symptoms, lubrication and pain during sexual intercourse, as scored at baseline and at post treatment
Notes An arm with 50 women who received only 1 Cal + D tablet (500 mg + 200 IU) was not considered
Timing: unclear
Location: Iran
Multi‐centre: only 2 sites (in Tehran)
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Computer‐generated list of random numbers
Allocation concealment (selection bias) Unclear risk No information provided
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Not specified whether blind/double‐blind trial. All women received Ca + vit D but 1 control group did not receive active treatments; no dummy placebo mentioned
Blinding of outcome assessment (detection bias) 
 All outcomes High risk Only blood samples stated to have been assessed in blinded fashion (corresponding outcome is not of interest for this review)
Incomplete outcome data (attrition bias) 
 All outcomes Unclear risk 5/150 lost to follow‐up for bleeding outcomes; 20/150 (13%) for vasomotor symptoms
Selective reporting (reporting bias) Unclear risk Study protocol not available
Conflict of interest Low risk Publicly financed; study authors state no competing interests

ADLS: Almedica Drug Labeling System

AE: adverse event.

BKMI: Blatt‐Kupperman menopausal index.

BMD: bone mineral density.

BMI: body mass index.

CE: conjugated oestrogen.

CEE: conjugated equine oestrogen.

ETTH: Episodic tension‐type headache

EV: oestradiol valerate.

FDA: Food and Drug Administration.

FSH: follicle‐stimulating hormone.

HRT: hormone replacement therapy.

HT: hormone therapy.

MPA: medroxyprogesterone acetate.

RCT: randomized controlled trial.

SLE: systemic lupus erythematosus.

TIA: transient ischaemic attack.

TVUS: transvaginal ultrasonography.

VM: vasomotor symptoms.