Effects of treatment with oestradiol/levonorgestrel on bone, lipoproteins and hormone status in postmenopausal women.
The aim of the study was to investigate the effects of an oestradiol/levonorgestrel regimen, administered parenterally, on bone metabolism, bone density, lipoprotein metabolism and hormone status. Twenty-five women who had undergone a surgical menopause had an oestradiol/levonorgestrel-containing vaginal ring pessary in situ for 6 months. Within the first month there were sustained changes in the biochemical indices of bone metabolism in keeping with a marked reduction in bone turnover and decrease in bone resorption. Bone mineral content in the distal forearm was measured in 14 patients and a small increase was noted in every patient. Levonorgestrel was well absorbed and the serum levels remained almost constant throughout treatment. There was a gradual increase in serum total oestradiol which became significant at 6 months. Dialysable oestradiol levels rose from 2.6% of total oestradiol at 0 time to 3.3% at 1 month with no further change thereafter. SHBG levels were 23% of pretreatment levels at 6 months. There were sustained decreases in triglyceride, VLDL and HDL cholesterol levels and a transient fall in LDL cholesterol. Total HDL, HDL2 and HDL3 cholesterol levels were reduced by 25, 40 and 21% respectively. The results suggest that levonorgestrel exerts a protective influence on bone either directly or by its effect on the proportion of oestradiol circulating in the free, physiologically active form. The effects on lipoproteins were predominately those of the progestogen component, the lipoprotein risk factors for coronary heart disease being adversely affected.
Farish
E
E
Department of Biochemistry, Stobhill General Hospital, Glasgow, UK.
Hart
D M
DM
Gray
C E
CE
Beastall
G
G
Fletcher
C D
CD
Lindsay
R
R
D000282:Administration, Intravaginal; D015519:Bone Density / Q000187:drug effects; D001862:Bone Resorption; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism; D004958:Estradiol / Q000378:metabolism / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D016912:Levonorgestrel; D008074:Lipoproteins / Q000378:metabolism*; D008593:Menopause / Q000187:drug effects*; D009644:Norgestrel / Q000378:metabolism / Q000627:therapeutic use*; D010570:Pessaries
D008074:Lipoproteins; D009644:Norgestrel; D004958:Estradiol; D016912:Levonorgestrel