Estetrol for the Treatment of Moderate to Severe Vasomotor Symptoms in Postmenopausal Women (E4Comfort Study I)

Phase 3

Completed

Conditions: Vasomotor Symptoms
Menopausal Symptoms

Interventions: Drug: Estetrol
Drug: Placebo
Drug: Progesterone

Registration Number: NCT04209543

Lead Sponsor: Estetra

Brief Summary: This is a two-part study designed to evaluate the effect of Estetrol (E4) 15 or 20 mg, or placebo on the severity and frequency of vasomotor symptoms (VMS) (Efficacy Study Part) and the safety of E4 20 mg (Endometrial and General Safety Study Part)

Detailed Description: This study consists of two-parts, performed with 2 separate groups of participants:

• Efficacy Study Part: Designed to evaluate the frequency and severity of vasomotor symptoms \[VMS\] in both hysterectomized and non-hysterectomized postmenopausal participants after treatment with E4 15 mg or 20 mg or placebo for up to 13 consecutive weeks. For endometrial protection, all non-hysterectomized participants were treated with 200 mg progesterone (P4) once daily for 14 consecutive days, after completion of the E4/placebo treatment. This part of the study consisted of 3 treatment groups.

• Safety Study Part: The Endometrial and General Safety Study Part is designed to evaluate the general safety, endometrial safety, secondary efficacy (lipid, glucose metabolism, health-related quality of life (HRQoL) and treatment satisfaction) of E4 in non-hysterectomized participants. All participants received E4 20 mg in combination with 100 mg P4 continuously for up to 53 weeks.

Recruitment & Eligibility

Status: COMPLETED

Sex: Female

Target Recruitment: 1570

Inclusion Criteria

Signed and dated written informed consent form and any required privacy authorization prior to the initiation of any trial procedure, after the nature of the trial has been explained according to local regulatory requirements;
Females, ≥ 40 up to ≤ 65 years of age at randomization;
For hysterectomized subjects: documented hysterectomy must have occurred at least 6 weeks prior to the start of screening. Hysterectomy can be total or subtotal (i.e., cervix was not removed);
For non-hysterectomized subjects: uterus with bi-layer endometrial thickness ≤ 4 mm on TVUS;
For non-hysterectomized subjects: an evaluable endometrial biopsy taken during screening that reveals no abnormal results, i.e., presence of hyperplasia (simple or complex, with or without atypia), presence of carcinoma, and presence of disordered proliferative endometrium findings. The screening biopsy should have sufficient endometrial tissue for diagnosis;
Seeking treatment for relief of VMS associated with menopause;
1. For the Efficacy Study part: at least 7 moderate to severe bothersome VMS per day or at least 50 moderate to severe bothersome VMS per week in the last 7 consecutive days during the Screening period;
2. For the Endometrial and General Safety Study part: at least 1 moderate to severe VMS per week;
Body mass index ≥ 18.0 kg/m^2 to ≤ 38.0 kg/m^2;
A mammogram that shows no sign of significant disease performed during screening or within 9 months prior to the start of screening ;
Post-menopausal status defined as any of the following:
For non-hysterectomized subjects:
1. at least 12 months of spontaneous amenorrhea with serum follicle stimulating hormone (FSH) >40 milli-International unit (mIU)/mL (value obtained after washout of estrogen/progestin containing drugs, see exclusion criteria 18 and 20);
2. or at least 6 months of spontaneous amenorrhea with serum FSH >40 mIU/mL and E2 <20 pg/mL (<73.4 pmol/L,value obtained after washout of estrogen/progestin containing drugs, see exclusion criteria 18 and 20);
3. or at least 6 weeks postsurgical bilateral oophorectomy;
For hysterectomized subjects:
1. serum FSH >40 mIU/mL and E2 <20 pg/mL (<73.4 pmol/L, values obtained after washout of estrogen/progestin containing drug see exclusion criteria 18 and 20);
2. or at least 6 weeks post-surgical bilateral oophorectomy.
Good physical and mental health, in the judgement of the Investigator as based on medical history, physical and gynecological examination and clinical assessments performed prior Visit 1;
Able to understand and comply with the protocol requirements, instructions, and protocol-stated restrictions;
Able and willing to complete trial daily paper diaries (if applicable) and questionnaires.

Exclusion Criteria

History of malignancy with the exception of basal cell or squamous cell carcinoma of the skin if diagnosed more than 1 year prior to the Screening visit;
Any clinically significant findings found by the Investigator at the breast examination and/or on mammography suspicious of breast malignancy that would require additional clinical testing to rule out breast cancer (however, simple cysts confirmed by ultrasound are allowed);
Papanicolaou (PAP) test with atypical squamous cells undetermined significance (ASC-US) or higher (low-grade intraepithelial lesion [LSIL], atypical squamous cells- cannot exclude high-grade intraepithelial lesion [HSIL] [ASC-H], HSIL, dysplastic or malignant cells) in sub-totally hysterectomized and non-hysterectomized subjects . Note: ASC-US is allowed if a reflex human papilloma virus (HPV) testing is performed and is negative for high risk oncogene HPV subtypes 16 and 18;
For non-hysterectomized subjects:
1. History or presence of uterine cancer, endometrial hyperplasia, or disordered proliferative endometrium;
2. Presence of endometrial polyps;
3. Undiagnosed vaginal bleeding or undiagnosed abnormal uterine bleeding;
4. Endometrial ablation;
5. Any uterine/endometrial abnormality that in the judgment of the investigator contraindicates the use of estrogen and/or progestin therapy. This includes presence or history of adenomyosis or significant myoma;
Systolic blood pressure (BP) higher than 130 mmHg, diastolic BP higher than 80 mmHg during screening;
History of venous or arterial thromboembolic disease (e.g., superficial or deep vein thrombosis, pulmonary embolism, stroke, myocardial infarction, angina pectoris, etc.), or first degree family history of venous thromboembolism (VTE);
History of known acquired or congenital coagulopathy or abnormal coagulation factors, including known thrombophilia's;
Laboratory values of fasting glucose above 125 mg/dL (>6.94 mmol/L) and/or glycated hemoglobin above 7%18;
Dyslipoproteinemia (LDL >190 mg/dL [>4.91 mmol/L] and/or triglycerides >300 mg/dL [>3.39 mmol/L])19;
Subjects smoking >15 cigarettes per day;
Presence or history of gallbladder disease, unless cholecystectomy has been performed;
Systemic lupus erythematosus;
Any malabsorption disorders including gastric by-pass surgery;
History of acute liver disease in the preceding 12 months before the start of screening or presence or history of chronic or severe liver disease [alanine transaminase (ALT) or aspartate transaminase (AST) >2x upper limit of normal (ULN), bilirubin >1.5 ULN]; or liver tumors;
Chronic or current acute renal impairment (estimated glomerular filtration rate <60 ml/min);
Porphyria;
Diagnosis or treatment of major psychiatric disorder (e.g., schizophrenia, bipolar disorder, etc.), in the judgement of the Investigator;
Use of estrogen/progestin containing drug(s) up to:
1. 1 week before screening start for vaginal non systemic hormonal products (rings, creams, gels);
2. 4 weeks before screening start for vaginal or transdermal estrogen or estrogen/progestin products;
3. 8 weeks before screening start for oral estrogen and/or progestin products and/or selective estrogen receptor modulator therapy;
4. 8 weeks before screening start for intrauterine progestin therapy;
5. 3 months before screening start for progestin implants or estrogen alone injectable drug therapy;
6. 6 months before screening start for estrogen pellet therapy or progestin injectable drug therapy;
Use of androgen/dehydroepiandrosterone (DHEA) containing drugs:
1. 8 weeks before screening start for oral, topical, vaginal or transdermal androgen;
2. 6 months before screening start for implantable or injectable androgen therapy;
Use of phytoestrogens or black cohosh for the treatment of VMS up to 2 weeks before the start of screening;
For the women participating in the Efficacy Study part: use of prescription or over-the-counter products used for the treatment of VMS, e.g., anti-depressants: paroxetine, escitalopram, methyldopa, opioid and clonidine up to 4 weeks before the start of screening, and venlafaxine and desvenlafaxine up to 3 months before the start of screening , and not willing to stop these during their participation in the trial;
Not willing to stop any hormonal products as described in exclusion criteria 18, 19 and 20, during their participation in the trial;
Inadequately treated hyperthyroidism with abnormal TSH and free T4 at screening. Subjects with low or high TSH are allowed if free T4 at screening is within normal range;
History or presence of allergy/intolerance to the investigational product or drugs of this class or any component of it, or history of drug or other allergy that, in the opinion of the Investigator contraindicates subject participation;
History of alcohol or substance abuse (including marijuana, even if legally allowed) or dependence in the previous 12 months before the start of screening as determined by the Investigator, based on reported observations;
Sponsor or contract research organization (CRO) employees or employees under the direct supervision of the Investigator and/or involved directly in the trial;
Subjects with known or suspected history of a clinically significant systemic disease, unstable medical disorders, life-threatening disease or current malignancies that would pose a risk to the subject in the opinion of the Investigator;
Participation in another investigational drug clinical trial within 1 month (30 days) or having received an investigational drug within the last month (30 days) before the start of screening;
Is judged by the Investigator to be unsuitable for any reason;
For non-hysterectomized subjects to be included in the USA and Canada: history or presence of allergy to peanuts.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Estetrol 15 mg - Efficacy Part	Estetrol	Estetrol (E4) 15 mg was administered orally once daily for a minimum of 12 weeks and not longer than 13 weeks.
Estetrol 20 mg - Efficacy Part	Estetrol	Estetrol (E4) 20 mg was administered orally once daily for a minimum of 12 weeks and not longer than 13 weeks.
Placebo - Efficacy Part	Placebo	Placebo was administered orally once daily for a minimum of 12 weeks and not longer than 13 weeks.
Estetrol 20 mg + P4 100 mg - Safety Part	Estetrol	Estetrol (E4) 20 mg and Progesterone (P4) 100 mg was administered once daily for up to 53 weeks.
Estetrol 20 mg + P4 100 mg - Safety Part	Progesterone	Estetrol (E4) 20 mg and Progesterone (P4) 100 mg was administered once daily for up to 53 weeks.

Primary Outcome Measures

Name	Time	Method
Mean change in weekly frequency of moderate to severe vasomotor symptoms (VMS) from Baseline to Week 4 (Efficacy Study Part)	Baseline and Week 4	The weekly frequency of moderate to severe VMS at Baseline and Week 4 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 4. Mean change = mean weekly frequency at Week 4 - mean weekly frequency at Baseline
Mean change in severity of moderate to severe vasomotor symptoms (VMS) from Baseline to Week 4 (Efficacy Study Part)	Baseline and Week 4	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 4 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 4. Baseline and Week 4 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 4 - mean severity score at Baseline
Mean change in severity of moderate to severe vasomotor symptoms (VMS) from Baseline to Week 12 (Efficacy Study Part)	Baseline and Week 12	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 12 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 12. Baseline and Week 12 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 12 - mean severity score at Baseline
Mean change in weekly frequency of moderate to severe vasomotor symptoms (VMS) from Baseline to Week 12 (Efficacy Study Part)	Baseline and Week 12	The weekly frequency of moderate to severe VMS at Baseline and Week 12 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 12. Mean change = mean weekly frequency at Week 12 - mean weekly frequency at Baseline
Incidence of endometrial hyperplasia with up to 12 months of treatment based on endometrial biopsies (Endometrial and General Safety Study Part)	Screening and Week 53	Endometrial biopsies will be centrally evaluated by three independent expert pathologists from different institutions, blinded to treatment group and to each other's readings. The concurrence of two of the three pathologists will be accepted as the final diagnosis. If there is no agreement among the three pathologists, the most severe pathologic diagnosis, i.e., atypical hyperplasia \>complex hyperplasia \>simple hyperplasia \>benign endometrium, will be used as the final diagnosis.

Secondary Outcome Measures

Name	Time	Method
Mean change from Baseline to Week 4 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy part)	Baseline and Week 4	The weekly frequency of moderate to severe VMS at Baseline and Week 4 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 4. Mean change = mean weekly frequency at Week 4 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 4 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 4. Baseline and Week 4 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 4 - mean severity score at Baseline
Mean change from Baseline to Week 2 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 2	The weekly frequency of moderate to severe VMS at Baseline and Week 2 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 2. Mean change = mean weekly frequency at Week 2 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 2 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 2. Baseline and Week 2 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 2 - mean severity score at Baseline
Mean change from Baseline to Week 7 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 7	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 7 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 7. Baseline and Week 7 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 7 - mean severity score at Baseline
Percentage of participants with 75% reduction from Baseline in the weekly frequency of mild, moderate, and severe VMS at Week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 (Efficacy Study Part)	Baseline, Week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12	The weekly frequency of moderate to severe VMS at Baseline and Week X is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization (Baseline) and day \[(X-1)\7+1\] to day X\7 (Week X).
Percentage of participants with a clinically important difference (CID) compared to baseline in the weekly frequency of moderate to severe VMS at Week 12 using the Clinical Global Impression (CGI) questionnaire (Efficacy Study Part)	Week 12	The CGI score is a seven point scale in which subjects will be asked to rate the total improvement, whether or not in her judgment it was due entirely to drug treatment, compared to her condition at admission to the study. Scale: Very much improved, Much improved, Minimally improved, No change, Minimally worse, Much worse, Very much worse.
Change from Baseline to Week 12 in plasma concentration of total cholesterol (Efficacy Study Part)	Baseline and Week 12
Change from Baseline to Week 12 in the total cholesterol/high density cholesterol (HDL) cholesterol ratio (Efficacy Study Part)	Baseline and Week 12
Change from Baseline to Week 12 in the HDL-cholesterol ratio (Efficacy Study Part)	Baseline and Week 12
Mean change from Baseline to Week 1 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 1	The weekly frequency of moderate to severe VMS at Baseline and Week 1 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 1. Mean change = mean weekly frequency at Week 1 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 1 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 1. Baseline and Week 1 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 1 - mean severity score at Baseline
Mean change from Baseline to Week 10 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 10	The weekly frequency of moderate to severe VMS at Baseline and Week 10 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 10. Mean change = mean weekly frequency at Week 10 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 10 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 10. Baseline and Week 10 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 10 - mean severity score at Baseline
Mean change from Baseline to Week 6 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 6	The weekly frequency of moderate to severe VMS at Baseline and Week 6 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 6. Mean change = mean weekly frequency at Week 6 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 6 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 6. Baseline and Week 6 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 6 - mean severity score at Baseline
Mean change from Baseline to Week 1 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 1	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 1 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 1. Baseline and Week 1 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 1 - mean severity score at Baseline
Mean change from Baseline to Week 3 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) ((Efficacy Study Part)	Baseline and Week 3	The weekly frequency of moderate to severe VMS at Baseline and Week 3 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 3. Mean change = mean weekly frequency at Week 3 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 3 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 3. Baseline and Week 3 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 3 - mean severity score at Baseline
Mean change from Baseline to Week 6 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 6	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 6 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 6. Baseline and Week 6 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 6 - mean severity score at Baseline
Change from Baseline to Week 12 in plasma concentration of lipoprotein (a) (Efficacy Study Part)	Baseline and Week 12
Change from Baseline to Week 12 in plasma concentration of glycated hemoglobin (Efficacy Study Part)	Baseline and Week 12
Mean change from Baseline to Week 5 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 5	The weekly frequency of moderate to severe VMS at Baseline and Week 5 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 5. Mean change = mean weekly frequency at Week 5 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 5 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 5. Baseline and Week 5 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 5 - mean severity score at Baseline
Mean change from Baseline to Week 7 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 7	The weekly frequency of moderate to severe VMS at Baseline and Week 7 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 7. Mean change = mean weekly frequency at Week 7 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 7 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 7. Baseline and Week 7 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 7 - mean severity score at Baseline
Mean change from Baseline to Week 8 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 8	The weekly frequency of moderate to severe VMS at Baseline and Week 8 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 8. Mean change = mean weekly frequency at Week 8 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 8 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 8. Baseline and Week 8 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 8 - mean severity score at Baseline
Mean change from Baseline to Week 9 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 9	The weekly frequency of moderate to severe VMS at Baseline and Week 9 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 9. Mean change = mean weekly frequency at Week 9 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 9 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 9. Baseline and Week 9 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 9 - mean severity score at Baseline
Mean change from Baseline to Week 11 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 11	The weekly frequency of moderate to severe VMS at Baseline and Week 11 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 11. Mean change = mean weekly frequency at Week 11 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 11 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 11. Baseline and Week 11 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 11 - mean severity score at Baseline
Mean change from Baseline to Week 12 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 12	The weekly frequency of moderate to severe VMS at Baseline and Week 12 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 12. Mean change = mean weekly frequency at Week 12 - mean weekly frequency at Baseline The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 12 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 12. Baseline and Week 12 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 12 - mean severity score at Baseline
Mean change from Baseline to Week 5 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 5	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 5 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 5. Baseline and Week 5 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 5 - mean severity score at Baseline
Mean change from Baseline to Week 8 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 8	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 8 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 8. Baseline and Week 8 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 8 - mean severity score at Baseline
Mean change from Baseline to Week 2 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 2	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 2 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 2. Baseline and Week 2 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 2 - mean severity score at Baseline
Mean change from Baseline to Week 3 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 3	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 3 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 3. Baseline and Week 3 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 3 - mean severity score at Baseline
Mean change from Baseline to Week 4 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 4	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 4 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 4. Baseline and Week 4 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 4 - mean severity score at Baseline
Mean change from Baseline to Week 9 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 9	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 9 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 9. Baseline and Week 9 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 9 - mean severity score at Baseline
Mean change from Baseline to Week 10 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 10	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 10 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 10. Baseline and Week 10 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 10 - mean severity score at Baseline
Mean change from Baseline to Week 11 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 11	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 11 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 11. Baseline and Week 11 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 11 - mean severity score at Baseline
Mean change from Baseline to Week 12 in the weekly frequency and severity of mild, moderate and severe vasomotor symptoms (VMS) (Efficacy Study Part)	Baseline and Week 12	The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 12 is defined as the arithmetic mean of the daily severity score values of mild, moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of mild, moderate and severe VMS observed at Week 12. Baseline and Week 12 severity score = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of mild + moderate + severe VMS). Mean change = mean severity score at Week 12 - mean severity score at Baseline
Percentage of participants with 50% reduction from Baseline in the weekly frequency of moderate to severe vasomotor symptoms (VMS) at Week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 (Efficacy Study Part)	Baseline, Week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12	The weekly frequency of moderate to severe VMS at Baseline and Week X is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization (Baseline) and day \[(X-1)\7+1\] to day X\7 (Week X).
Percentage of participants with 50% reduction from Baseline in the weekly frequency of mild, moderate, and severe vasomotor symptoms (VMS) at Week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 (Efficacy Study Part)	Baseline, Week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12	The weekly frequency of moderate to severe VMS at Baseline and Week X is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization (Baseline) and day \[(X-1)\7+1\] to day X\7 (Week X).
Percentage of participants with 75% reduction from Baseline in the weekly frequency of moderate to severe VMS at Week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 (Efficacy Study Part)	Baseline, Week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12	The weekly frequency of moderate to severe VMS at Baseline and Week X is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization (Baseline) and day \[(X-1)\7+1\] to day X\7 (Week X).
Frequency of subjects in the different endometrial categories according to Blaustein's pathology (Efficacy Study Part)	Screening and Week 13	Endometrial biopsies will be centrally evaluated by three independent expert pathologists from different institutions, blinded to treatment group and to each other's readings. The concurrence of two of the three pathologists will be accepted as the final diagnosis. If there is no agreement among the three pathologists, the most severe pathologic diagnosis, i.e., atypical hyperplasia \>complex hyperplasia \>simple hyperplasia \>benign endometrium, will be used as the final diagnosis.
Change from Baseline to Weeks 12 and 52 in plasma concentration of low-density lipoprotein (LDL)-cholesterol (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52
Change from Baseline to Weeks 12 and 52 in plasma concentration of total cholesterol (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52
Change from Baseline to Weeks 12 and 52 in Homeostasis model-assessment-estimated insulin resistance (HOMA-IR) (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52
Change from Baseline to each measured time point in endometrial thickness (Endometrial and General Safety Study Part)	Screening, Baseline, Weeks 13, 29, and 53	Endometrial thickness will be assessed by transvaginal ultrasound (TVUS).
Percentage of participants with a clinically important difference (CID) compared to Baseline in the weekly frequency of moderate to severe VMS at Week 4 using the Clinical Global Impression (CGI) questionnaire (Efficacy Study Part)	Week 4	The CGI score is a seven point scale in which subjects will be asked to rate the total improvement, whether or not in her judgment it was due entirely to drug treatment, compared to her condition at admission to the study. Scale: Very much improved, Much improved, Minimally improved, No change, Minimally worse, Much worse, Very much worse.
Change from Baseline to Week 12 in vulvovaginal atrophy (VVA) symptoms (Efficacy Study Part)	Baseline and Week 12	Genitourinary syndrome of menopause (GSM) will be assessed by the subjects using the vulvovaginal atrophy (VVA) self assessment questionnaire. The following GSM symptoms will be assessed: * Vaginal dryness * Vaginal and/or vulvar irritation/itching * Dysuria * Vaginal pain associated with sexual activity * Vaginal bleeding associated with sexual activity All GSM symptoms except vaginal bleeding associated with sexual activity will be graded by the participants using the following scale: \[0\] none, \[1\] mild, \[2\] moderate, or \[3\] severe. Vaginal bleeding associated with sexual activity is documented using 2 categories: \[0\] absent or \[1\] present. A negative change from baseline score indicates improvement in symptoms.
Change from Baseline to Week 12 in the vulvovaginal atrophy (VVA) symptom that is initially identified by the participant as being the most bothersome using the VVA questionnaire at baseline (Efficacy Study Part)	Baseline and Week 12	Genitourinary syndrome of menopause (GSM) will be assessed by the subjects using the vulvovaginal atrophy (VVA) self assessment questionnaire. The following GSM symptoms will be assessed: * Vaginal dryness * Vaginal and/or vulvar irritation/itching * Dysuria * Vaginal pain associated with sexual activity * Vaginal bleeding associated with sexual activity All GSM symptoms except vaginal bleeding associated with sexual activity were graded by the participants using the following scale: \[0\] none, \[1\] mild, \[2\] moderate, or \[3\] severe. Vaginal bleeding associated with sexual activity was documented using 2 categories: \[0\] absent or \[1\] present. A negative change from baseline score indicates improvement in symptoms. At baseline the participant will be asked which of the above mentioned symptoms she identifies as being the most bothersome.
Change from Baseline to Week 12 in plasma concentration of triglycerides (Efficacy Study Part)	Baseline and Week 12
Change from Baseline to Week 12 in plasma concentration of low-density lipoprotein (LDL)-cholesterol (Efficacy Study Part)	Baseline and Week 12
Change from Baseline to Weeks 12 and 52 in the total cholesterol/high density cholesterol (HDL) cholesterol ratio (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52
Change from Baseline to Weeks 12 and 52 in plasma concentration of lipoprotein (a) (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52
Frequency of subjects in the different endometrial categories according to Blaustein's pathology (Endometrial and General Safety Study Part)	Screening and Week 53	Endometrial biopsies will be centrally evaluated by three independent expert pathologists from different institutions, blinded to treatment group and to each other's readings. The concurrence of two of the three pathologists will be accepted as the final diagnosis. If there is no agreement among the three pathologists, the most severe pathologic diagnosis, i.e., atypical hyperplasia \>complex hyperplasia \>simple hyperplasia \>benign endometrium, will be used as the final diagnosis.
Change from Baseline to Week 12 in fasting glycaemia (Efficacy Study part)	Baseline and Week 12
Change from Baseline to Week 12 in plasma concentration of insulin (Efficacy Study Part)	Baseline and Week 12
Change from Baseline to Week 12 in Homeostasis model-assessment-estimated insulin resistance (HOMA-IR) (Efficacy Study Part)	Baseline and Week 12
Number of participants with treatment-emergent adverse events (TEAEs) (Efficacy Study Part)	From baseline to Follow-up visit (up to Week 16)	TEAEs are those adverse events occurring from time point of first ingestion of investigational product until last visit or any event already present that worsens in either intensity or frequency following exposure to the treatment.
Number of participants with changes in physical and gynecological examination results (Efficacy Study Part)	Screening and Week 13	Physical examination will include an examination of general appearance, head, eyes, ears, nose, throat, skin, neck, lungs, breast, lymph nodes, abdomen, and the cardiovascular musculoskeletal and neurological systems. Gynecological examination will include a manual pelvic examination.
Change from baseline to Week 12 in health-related quality of life assessment (HRQoL) using the menopause-specific Quality of Life (MENQOL) questionnaire (Efficacy Study Part)	Baseline and Week 12	The MENQOL is self-administered questionnaire which will assess changes in quality of life over a one-month period. It is composed of 29 questions indicating if subject experienced the problem (Yes/No) and if Yes, rating scale ranged from 0=Not bothered at all to 6=Extremely bothered. For analysis, the original scores will be converted to the analysis score ranging from 1-8 where No=1, 0=2, 1=3...and 6=8. The scale contains four domains: vasomotor, psychosocial, physical and sexual. Each domain is scored separately. Vasomotor domain score is mean of = Q1,Q2, Q3, with 1 being "not at all bothered" and 8 being "extremely bothered".
Total score in treatment satisfaction using the Clinical Global Impression (CGI) questionnaire (Efficacy Study Part)	Weeks 4 and 12	The CGI score is a seven point scale in which subjects will be asked to rate the total improvement, whether or not in her judgment it was due entirely to drug treatment, compared to her condition at admission to the study. Scale: Very much improved, Much improved, Minimally improved, No change, Minimally worse, Much worse, Very much worse.
Number of participants with changes in electrocardiogram (ECG) results (Efficacy Study Part)	Screening and Week 13	The ECG interpretation scheme will include the analysis of the morphology, rhythm, conduction, ST segment, PR, QRS, QT and corrected QT (QTc) intervals, T waves, U waves and the presence or absence of any pathological changes.
Change from baseline to each measured time point in endometrial thickness (Efficacy Study Part)	Screening, Week 13, Week 16	Endometrial thickness will be assessed by transvaginal ultrasound (TVUS). Baseline: data will be recorded at Screening.
Number of participants with changes in vital sign results (Efficacy Study Part)	From screening to Week 13	Vital signs will include height, body weight, body mass index, sitting systolic and diastolic blood pressures, and heart rate.
Number of participants with changes in breast examination results (Efficacy Study Part)	Screening and Week 13
Number of participants with changes in routine clinical laboratory test results (Efficacy Study Part)	Screening, Baseline and Week 13	Routine laboratory tests include hematology and chemistry.
Number of participants with vaginal bleeding and/or spotting during each 28-day cycle of treatment with E4 (Efficacy Study Part)	From Baseline up to Follow-up (Week 16)	Vaginal bleeding will be daily recorded by the participant on the diary. Absence or occurrence of vaginal bleeding/ spotting will be assessed using the scale below: 0 = Absence of vaginal bleeding or spotting; 1 = Spotting: evidence of minimal blood loss requiring none or at most one pad, tampon or panty liner per day; 2 = Bleeding: evidence of blood loss requiring more than one pad, tampon or panty liner per day.
Number of days with bleeding and/or spotting during each 28-day cycle of treatment (Efficacy Study Part)	From Baseline up to Follow-up (Week 16)	Vaginal bleeding will be daily recorded by the participant on the diary. Absence or occurrence of vaginal bleeding/spotting will be assessed using the scale below: 0 = Absence of vaginal bleeding or spotting; 1 = Spotting: evidence of minimal blood loss requiring none or at most one pad, tampon or panty liner per day; 2 = Bleeding: evidence of blood loss requiring more than one pad, tampon or panty liner per day.
Number of participants with amenorrhea (absence of any bleeding or spotting) during each 28-day cycle of treatment with E4 (Efficacy Study Part)	From Baseline up to Follow-up (Week 16)	Vaginal bleeding will be daily recorded by the participant on the diary. Absence or occurrence of vaginal bleeding/ spotting will be assessed using the scale below: 0 = Absence of vaginal bleeding or spotting; 1 = Spotting: evidence of minimal blood loss requiring none or at most one pad, tampon or panty liner per day; 2 = Bleeding: evidence of blood loss requiring more than one pad, tampon or panty liner per day.
Cumulative rates of amenorrhea (Efficacy Study Part)	From Baseline up to Follow-up (Week 16)	The rate of amenorrhea is defined as the percentage of women who reported consecutive cycles of amenorrhea for a given cycle of time.
Number of participants with treatment-emergent adverse events (TEAEs) (Endometrial and General Safety Part)	From baseline to Week 53	TEAEs are those adverse events occurring from time point of first ingestion of investigational product until last visit or any event already present that worsens in either intensity or frequency following exposure to the treatment.
Number of participants with changes in physical and gynecological examination results (Endometrial and General Safety Part)	Screening and Week 53	Physical examination will include an examination of general appearance, head, eyes, ears, nose, throat, skin, neck, lungs, breast, lymph nodes, abdomen, and the cardiovascular musculoskeletal and neurological systems. Gynecological examination will include a manual pelvic examination.
Number of participants with changes in vital sign results (Endometrial and General Safety Part)	From screening to Week 53	Vital signs will include height, body weight, body mass index, sitting systolic and diastolic blood pressures, and heart rate.
Number of participants with changes in breast examination results (Endometrial and General Safety Part)	From screening to Week 53	Vital signs will include height, body weight, body mass index, sitting systolic and diastolic blood pressures, and heart rate.
Number of participants with changes in electrocardiogram (ECG) results (Endometrial and General Safety Part)	Screening and Week 53	The ECG interpretation scheme will include the analysis of the morphology, rhythm, conduction, ST segment, PR, QRS, QT and corrected QT (QTc) intervals, T waves, U waves and the presence or absence of any pathological changes.
Number of participants with changes in mammography results (Endometrial and General Safety Part)	Screening and Week 53
Number of participants with changes in routine clinical laboratory test results (Endometrial and General Safety Part)	Screening, Baseline and Week 13	Routine laboratory tests include hematology and chemistry.
Number of women with vaginal bleeding and/or spotting during each 28-day cycle of treatment with E4 (Endometrial and General Safety Part)	From Baseline to Week 53	Vaginal bleeding will be daily recorded by the participant on the diary. Absence or occurrence of vaginal bleeding/spotting will be assessed using the scale below: 0 = Absence of vaginal bleeding or spotting; 1 = Spotting: evidence of minimal blood loss requiring none or at most one pad, tampon or panty liner per day; 2 = Bleeding: evidence of blood loss requiring more than one pad, tampon or panty liner per day.
Number of days with bleeding and/or spotting during each 28-day cycle of treatment (Endometrial and General Safety Part)	From Baseline to Week 53	Vaginal bleeding will be daily recorded by the participant on the diary. Absence or occurrence of vaginal bleeding/spotting will be assessed using the scale below: 0 = Absence of vaginal bleeding or spotting; 1 = Spotting: evidence of minimal blood loss requiring none or at most one pad, tampon or panty liner per day; 2 = Bleeding: evidence of blood loss requiring more than one pad, tampon or panty liner per day.
Number of participants with amenorrhea (absence of any bleeding or spotting) during each 28-day cycle of treatment with E4 (Endometrial and General Safety Part)	From Baseline to Week 53	Vaginal bleeding will be daily recorded by the participant on the diary. Absence or occurrence of vaginal bleeding/spotting will be assessed using the scale below: 0 = Absence of vaginal bleeding or spotting; 1 = Spotting: evidence of minimal blood loss requiring none or at most one pad, tampon or panty liner per day; 2 = Bleeding: evidence of blood loss requiring more than one pad, tampon or panty liner per day.
Cumulative rates of amenorrhea (Endometrial and General Safety Part)	From Baseline to Week 53	The rate of amenorrhea is defined as the percentage of women who reported consecutive cycles of amenorrhea for a given cycle of time.
Change from Baseline to Weeks 12 and 52 in health-related quality of life assessment (HRQoL) using the menopause-specific Quality of Life (MENQOL) questionnaire (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52	The MENQOL is self-administered questionnaire which will assess changes in quality of life over a one-month period. It is composed of 29 questions indicating if subject experienced the problem (Yes/No) and if Yes, rating scale ranged from 0=Not bothered at all to 6=Extremely bothered. For analysis, the original scores were converted to the analysis score ranging from 1-8 where No=1, 0=2, 1=3...and 6=8. The scale contains four domains: vasomotor, psychosocial, physical and sexual. Each domain is scored separately. Vasomotor domain score is mean of = Q1,Q2, Q3, with 1 being "not at all bothered" and 8 being "extremely bothered".
Total score in treatment satisfaction assessed after 4, 12 and 52 weeks of treatment using the Clinical Global Impression (CGI) questionnaire (Endometrial and General Safety Part)	Weeks 4, 12, and 52	The CGI score is a seven point scale in which subjects will be asked to rate the total improvement, whether or not in her judgment it was due entirely to drug treatment, compared to her condition at admission to the study. Scale: Very much improved, Much improved, Minimally improved, No change, Minimally worse, Much worse, Very much worse.
Change from Baseline to Weeks 12 and 52 in plasma concentration of triglycerides (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52
Change from Baseline to Weeks 12 and 52 in plasma concentration of high-density lipoprotein (HDL)-cholesterol (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52
Change from Baseline to Weeks 12 and 52 in fasting glycaemia (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52
Change from Baseline to Weeks 12 and 52 in plasma concentration of insulin (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52
Change from Baseline to Weeks 12 and 52 in plasma concentration of glycated hemoglobin (Endometrial and General Safety Part)	Baseline and Weeks 12 and 52

Trial Locations

Locations (183): Estetra Study Site
🇬🇧
Orpington, United Kingdom
Noble Clinical Research
🇺🇸
Tucson, Arizona, United States
Infinite Clinical Trials
🇺🇸
Morrow, Georgia, United States
ETYKA Osrodek Badan Klinicznych
🇵🇱
Olsztyn, Poland
Centro Medico Dra Laura Maffei Investigacion Clinica Aplicada
🇦🇷
Caba, Argentina
Signature Gyn Services
🇺🇸
Fort Worth, Texas, United States
Faculdade de Medicina de Botucatu - UNESP
🇧🇷
Botucatu, Brazil
IDIM - Instituto de Investigaciones Metabolicas
🇦🇷
Buenos Aires, Argentina
Centro De Pesquisa Clinica Do Brasil
🇧🇷
Brasília, Brazil
Klaipedos Miesto Poliklinika
🇱🇹
Klaipėda, Lithuania
Universita degli Studi di Roma La Sapienza - Umberto I Policlinico di Roma
🇮🇹
Roma, Italy
Nzoz Zieniewicz Medical
🇵🇱
Warsaw, Poland
Spitalul Clinic Nicolae Malaxa
🇷🇴
Bucharest, Romania
Centrul Medical Euromed
🇷🇴
Bucuresti, Romania
Astarta Clinic
🇷🇺
Saint Petersburg, Russian Federation
Accellacare - (MeDiNova Limited) - Yorkshire
🇬🇧
Shipley, United Kingdom
San Marcus Research Clinic, Inc.
🇺🇸
Miami Lakes, Florida, United States
Medical Research Center of Miami II
🇺🇸
Miami, Florida, United States
Tidewater Clinical Research Inc
🇺🇸
Virginia Beach, Virginia, United States
Miami Clinical Research
🇺🇸
Miami, Florida, United States
Physician Care Clinical Research, LLC
🇺🇸
Sarasota, Florida, United States
Cedar Health Research, LLC
🇺🇸
Dallas, Texas, United States
Biopharma Informatic, Inc. Research Center
🇺🇸
Houston, Texas, United States
IMA Clinical Research
🇺🇸
Morgantown, West Virginia, United States
Genoma Research Group, Inc.
🇺🇸
Miami, Florida, United States
Hassman Research Institute
🇺🇸
Berlin, New Jersey, United States
Clinical Trials Research
🇺🇸
Sacramento, California, United States
SC Centrul Medical Unirea SRL
🇷🇴
Târgu-Mureş, Romania
Sana Monitoring
🇷🇴
Bucuresti, Romania
Public Institution Centro Poliklinika
🇱🇹
Vilnius, Lithuania
BrenCare, s. r. o.
🇸🇰
Poprad, Slovakia
Centrul Medical Unirea
🇷🇴
Constanta, Romania
Precision Trials AZ, LLC
🇺🇸
Phoenix, Arizona, United States
Jubilee Clinical Research, Inc
🇺🇸
Las Vegas, Nevada, United States
Excel Clinical Research
🇺🇸
Las Vegas, Nevada, United States
DIEX Research Quebec
🇨🇦
Quebec City, Canada
Scientific Centre Of Obsterics, Gynecology And Perinatology n.a.academican V.I.Kulakov of Federal Agency of High Tech Medical Care
🇷🇺
Moscow, Russian Federation
Glenny Corp. S. A. / Bioclinica Argentina
🇦🇷
Ciudad Autonoma de Buenos Aires, Argentina
Hope Clinical Research, LLC
🇺🇸
Canoga Park, California, United States
Velocity Clinical Research
🇺🇸
Denver, Colorado, United States
Clinical Neuroscience Solutions, Inc.
🇺🇸
Jacksonville, Florida, United States
Altus Research
🇺🇸
Lake Worth, Florida, United States
Fellows Research Alliance, Inc.
🇺🇸
Savannah, Georgia, United States
Praetorian Pharmaceutical Research
🇺🇸
Marrero, Louisiana, United States
Clinical Research Prime
🇺🇸
Idaho Falls, Idaho, United States
Meridian Clinical Research
🇺🇸
Norfolk, Nebraska, United States
Bosque Women's Care
🇺🇸
Albuquerque, New Mexico, United States
Magnolia Ob/Gyn Research Center
🇺🇸
Myrtle Beach, South Carolina, United States
PMG Research of Charlotte, LLC
🇺🇸
Charlotte, North Carolina, United States
Cedar Health Research LLC
🇺🇸
Irving, Texas, United States
Northwest Clinical Research Center
🇺🇸
Bellevue, Washington, United States
Mautalen Salud e Investigacion
🇦🇷
Ciudad Autonoma de Buenos Aires, Argentina
Fundacion Respirar (Centro Medico Dra. De Salvo) - Instituto Argentino de Investigaciones Clinicas (IAIC) S.R.L
🇦🇷
Ciudad Autonoma de Buenos Aires, Argentina
Centro de Investigacion Medico Lanus-CIMEL
🇦🇷
Lanús, Argentina
Centro De Investigaciones Medicas Mar Del Plata
🇦🇷
Mar Del Plata, Argentina
Centro De Medicina Reprodutiva Ltda - Clinica Origen
🇧🇷
Belo Horizonte, Brazil
Instituto de Investigaciones Clinicas Mar del Plata
🇦🇷
Mar Del Plata, Argentina
Instituto Medico de la Fundacion Estudios Clinicos
🇦🇷
Rosario, Argentina
IPCC-Instituto de Pesquisa Clinica de Campinas
🇧🇷
Campinas, Brazil
University of Campinas Medical School
🇧🇷
Campinas, Brazil
Centro de Oncologia de Santa Catarina Ltda / Supera Oncologia
🇧🇷
Chapeco, Brazil
Instituto Tropical de Medicina Reprodutiva - Clinica INTRO
🇧🇷
Cuiabá, Brazil
Federal University Of Ceara
🇧🇷
Fortaleza, Brazil
CEPEME / CERHFAC Centro De Estudos E Pesquisas Em Reproducao Humana E Fertilizacao Assistida De Curitiba Ltda
🇧🇷
Curitiba, Brazil
Universidade Federal Do Rio Grande Do Norte/ Maternidade Escola Januario Cicco
🇧🇷
Natal, Brazil
Hospital Sao Vicente de Paulo, Associacao Hospitalar Beneficente Sao Vicente de Paulo
🇧🇷
Passo Fundo, Brazil
Nucleo de Pesquisa Clinica do Rio Grande do Sul Ltda
🇧🇷
Porto Alegre, Brazil
Hospital de Clinicas de Porto Alegre (HCPA)
🇧🇷
Porto Alegre, Brazil
Unidade de Pesquisa Clínica - Centro de Medicina Reprodutiva
🇧🇷
Porto Alegre, Brazil
Hospital Sao Lucas da PUC
🇧🇷
Porto Alegre, Brazil
lnstituto Brasil De Pesquisa Clinica S.A (IBPCLIN)
🇧🇷
Rio De Janeiro, Brazil
CPQuali Pesquisa Clinica LTDA
🇧🇷
Sao Paulo, Brazil
CEMEC - Faculdade de Medicina do ABC
🇧🇷
São Bernardo Do Campo, Brazil
Hospital Perola Byington/ Centro de Referencia da Saude da Mulher
🇧🇷
São Paulo, Brazil
Universidade Federal De Sao Paulo (Unifesp) - Hospital Sao Paulo (Hsp)
🇧🇷
São Paulo, Brazil
CPClin- Centro de Pesquisas Clinicas Ltda./Clinica Dr. Freddy Goldberg Eliaschewitz
🇧🇷
São Paulo, Brazil
CEPIC - Centro Paulista de Investigacao Clinica e Servicos Medicos Ltda
🇧🇷
São Paulo, Brazil
Santa Casa De Votuporanga-Philanthropic hospital
🇧🇷
Votuporanga, Brazil
College - Centro De Pesquisa Clinica E Servicos Medicos Ltda College - Centro De Pesquisa Clinica (Baby Center Medicina Reprodutiva)
🇧🇷
São Paulo, Brazil
CEDOES - Centro de Diagnostico e Pesquisa da Osteoporose do Espirito Santo
🇧🇷
Vitória, Brazil
Alpha Recherche Clinique
🇨🇦
Québec, Canada
Aggarwal and Associates Limited
🇨🇦
Brampton, Canada
Clinique Rsf Inc.
🇨🇦
Quebec, Canada
Fadia El Boreky Medicine Professional Corporation
🇨🇦
Waterloo, Canada
Dr. Vladimir Dvorak MD, Office Of
🇨🇿
Brno, Czechia
Diex Research Sherbrooke Inc.
🇨🇦
Sherbrooke, Canada
Diex Recherche
🇨🇦
Victoriaville, Canada
Dr. Jiri Tiser MD, Office of
🇨🇿
Ceske Budejovice, Czechia
Gynekologie Cheb s.r.o.
🇨🇿
Cheb, Czechia
Gynekologie Meda Brno
🇨🇿
Brno, Czechia
MUDr. Martin Stepan s.r.o.
🇨🇿
Hradec Králové, Czechia
Gynekologie Jihlava
🇨🇿
Jihlava, Czechia
MUDr. Jan Kestranek - gynekologicka ambulance
🇨🇿
Nachod, Czechia
G-CENTRUM Olomouc, s.r.o.
🇨🇿
Olomouc, Czechia
NEUMED gynekologicka ambulance s.r.o.
🇨🇿
Olomouc, Czechia
Dr. Karel Buchta MD, Office of
🇨🇿
Ostrava, Czechia
Dr. Martina Maresova Rosenbergova MD, Office of
🇨🇿
Plzen, Czechia
Gynekologicka ambulance Gyncare MUDr. Michael Svec s.r.o.
🇨🇿
Plzen, Czechia
Mediva s.r.o
🇨🇿
Praha 5, Czechia
Dr. Lubomir Mikulasek, MD office Of
🇨🇿
Praha 9, Czechia
Gynekologicko-porodnicka klinika
🇨🇿
Praha 8, Czechia
Vestra Clinics
🇨🇿
Rychnov nad Kneznou, Czechia
Dr. Tereza Smrhova-Kovacs MD, Office of
🇨🇿
Tábor, Czechia
GYN-Mika s.r.o.
🇨🇿
České Budějovice, Czechia
MUDr. Petr Sak
🇨🇿
České Budějovice, Czechia
Szent Anna Privat Surgery-Szent Anna Maganrendelo
🇭🇺
Debrecen, Hungary
Dr. Ivana Salamonova MD, Office of
🇨🇿
Vysoke, Czechia
Pecsi Tudomanyegyetem (PTE) Altalanos Orvostudomanyi Kar (AOK) - Klinikai Kozpont Szuleszeti es Nogyogyaszati Klinika
🇭🇺
Pécs, Hungary
Univ. of Szeged Faculty of General Medicine Albert Szent-Gyaergyi
🇭🇺
Szeged, Hungary
Ginecologia e Fisiopatologia della Riproduzione Umana,UO Ostetricia e Ginecologia,Policlinico S.Orsola-Malpighi
🇮🇹
Bologna, Italy
Ospedale Pugliese
🇮🇹
Calabria, Italy
Universita degli Studi di Firenze - Azienda Ospedaliero Universitaria Careggi, DAI Materno Infantile, SOD Ginecologia e Ostetricia
🇮🇹
Firenze, Italy
Azienda Ospedaliero - Universitaria Policlinico di Modena
🇮🇹
Modena, Italy
Csongrad Megyei Dr. Bugyi Istvan Korhaz
🇭🇺
Szentes, Hungary
Universita degli Studi di Perugia - Policlinico Monteluce - Centro di Medicina Perinatale e della Riproduzione
🇮🇹
Perugia, Italy
Azienda Ospedaliero Universitaria Pisana
🇮🇹
Pisa, Italy
Policlinico Univ. Agostino Gemelli
🇮🇹
Roma, Italy
Saules Family Medicine Centre
🇱🇹
Kaunas, Lithuania
UAB VAKK - Dr. Kildos Klinika
🇱🇹
Kaunas, Lithuania
UAB Seimos gydytojas
🇱🇹
Vilnius, Lithuania
JSC Kardiolita
🇱🇹
Vilnius, Lithuania
JSC Maxmeda
🇱🇹
Vilnius, Lithuania
Osrodek Badan Klinicznych IN-VIVO
🇵🇱
Bydgoszcz, Poland
Vilnius University Hospital Santaros klinikos
🇱🇹
Vilnius, Lithuania
Centrum Ginekologii Endokrynologii i Medycyny Rozrodu Artemida
🇵🇱
Białystok, Poland
Prywatna Klinika Polozniczo - Ginekologiczna Sp. Z O.O.
🇵🇱
Białystok, Poland
Mital Site Badania Kliniczne
🇵🇱
Elbląg, Poland
Copernicus Podmiot Leczniczy - Szpital sw. Wojciecha
🇵🇱
Gdańsk, Poland
Przychodnia Srodmiescie Sp. z o.o.
🇵🇱
Bydgoszcz, Poland
Centrum Medyczne Mikolowska Dr Adam Sipinski
🇵🇱
Katowice, Poland
Clinical Medical Research sp. z o.o.
🇵🇱
Katowice, Poland
NZOZ Sanas
🇵🇱
Katowice, Poland
Centrum Medyczne Angelius Provita
🇵🇱
Katowice, Poland
Pro Familia Altera Sp. z o.o.
🇵🇱
Katowice, Poland
NZOZ Vita Longa Sp. z o.o.
🇵🇱
Katowice, Poland
Gyncentrum Sp. z o.o.
🇵🇱
Katowice, Poland
Pratia MCM Krakow
🇵🇱
Kraków, Poland
Grazyna Bogutyn Medico Praktyka Lekarska
🇵🇱
Kraków, Poland
KO-MED Centra Kliniczne Sp. z o.o., Osrodek Badan Klinicznych w Lublinie II
🇵🇱
Lublin, Poland
Centrum Medyczne Chodzki
🇵🇱
Lublin, Poland
NZOZ Medican
🇵🇱
Lodz, Poland
Niepubliczny Zak¿ad Opieki Zdrowotnej PROFI-MED
🇵🇱
Lublin, Poland
Clinical Research Center Spolka z ograniczona odpowiedzialnoscia Medic-R Spolka Komandytowa
🇵🇱
Poznań, Poland
Centrum Innowacyjnych Terapii Sp. z o.o.
🇵🇱
Piaseczno, Poland
Centrum Badawcze Wspolczesnej Terapii Prywatny Gabinet Lekarski Dr Anna Bochenek-Mularczyk
🇵🇱
Warszawa, Poland
Twoja Przychodnia - Szczecinskie Centrum Medyczne
🇵🇱
Szczecin, Poland
ETG Warszawa
🇵🇱
Warszawa, Poland
Marek Elias Gabinety Ginekologiczne
🇵🇱
Wroclaw, Poland
Spitalul De Urgenta Targu Mures-Emergency University County Hospital
🇷🇴
Târgu-Mureş, Romania
Centrul Medical Unirea Policlinica Brasov
🇷🇴
Braşov, Romania
ETG Zamosc
🇵🇱
Zamość, Poland
Salve Medica-Przychodnia
🇵🇱
Łódź, Poland
Centrul Medical de Diagnostic si Tratament Ambulatoriu Neomed SRL
🇷🇴
Braşov, Romania
SC Quantum Medical Center SRL
🇷🇴
Bucuresti, Romania
Spitalul Municipal Caracal
🇷🇴
Caracal, Romania
Centrul Medical Unirea - Spitalul Baneasa
🇷🇴
Bucuresti, Romania
Vitaplus Medclin SRL
🇷🇴
Craiova, Romania
Scientific Center for Family Health Problems and Human Reproduction
🇷🇺
Irkutsk, Russian Federation
Saint-Petersburg State Healthcare Institution Maternity hospital
🇷🇺
Saint Petersburg, Russian Federation
Krasnoyarsk State Medical University named after Prof. V.F. VoinoYasenetsky
🇷🇺
Krasnoyarsk, Russian Federation
LLC Olla-Med
🇷🇺
Moscow, Russian Federation
JCS Avicenna
🇷🇺
Novosibirsk, Russian Federation
Clinical diagnostic center Zdorovye
🇷🇺
Rostov-on-Don, Russian Federation
The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott - Center Menopause and Women's Health
🇷🇺
Saint Petersburg, Russian Federation
Diatros S.L.P
🇪🇸
Gavà, Spain
Woman's consulting center #22
🇷🇺
Saint Petersburg, Russian Federation
MCM GYNPED, s.r.o.
🇸🇰
Dubnica nad Váhom, Slovakia
Hospital Clinico San Carlos
🇪🇸
Madrid, Spain
Closed Joint Stock Company Medical Company Idk
🇷🇺
Samara, Russian Federation
Instituto Palacios, Salud y Medicina de la Mujer
🇪🇸
Madrid, Spain
Hospital Universitario Virgen del Rocio, Hospital de la Mujer
🇪🇸
Sevilla, Spain
Accellacare - (MeDiNova Limited) - Northamptonshire
🇬🇧
Corby, United Kingdom
CPS Research
🇬🇧
Glasgow, United Kingdom
Queen Charlotte's and Chelsea Hospital - Imperial College Healthcare NHS Trust
🇬🇧
London, United Kingdom
Accellacare (Previously MeDiNova) Warwickshire Quality Research Site
🇬🇧
Coventry, United Kingdom
Egin Research Ltd
🇬🇧
High Wycombe, United Kingdom
Accellacare - (MeDiNova Limited) - North London
🇬🇧
Northwood, United Kingdom
Accellacare - (MeDiNova Limited) - East London
🇬🇧
Romford, United Kingdom
Accellacare - South London
🇬🇧
Orpington, United Kingdom
Accellacare - (MeDiNova Limited) - West London
🇬🇧
Wokingham, United Kingdom
Medical Concierge Centrum Medyczne
🇵🇱
Warszawa, Poland
IRMED Osrodek Badan Klinicznych
🇵🇱
Piotrków Trybunalski, Poland
Clinical Neurosciecne Solutions, Inc. dba CNS Healthcare
🇺🇸
Orlando, Florida, United States