Long-term effects of oral and transdermal hormone replacement therapies on serum lipid and lipoprotein concentrations.
OBJECTIVE
To see whether the short-term changes in serum lipid and lipoprotein concentrations induced by postmenopausal estrogen-progestin therapy are maintained in the long term.


METHODS
Sixty-one healthy postmenopausal women were randomized to either oral therapy (continuous conjugated equine estrogens at 0.625 mg/day with sequential dl-norgestrel at 0.15 mg/day for 12 days each cycle) or transdermal therapy (patches delivering continuous 17 beta-estradiol [E2] at 0.05 mg/day with sequential norethindrone acetate at 0.25 mg/day for 14 days each cycle). Twenty-nine healthy postmenopausal women who did not request therapy served as a reference group. Fasting serum lipid and lipoprotein concentrations were monitored for 3 years.


RESULTS
Studied in the estrogen-progestin phase, oral and transdermal therapies reduced serum total cholesterol concentrations by 12.1% (P < .001) and 8.4% (P < .001), respectively, and those of low-density lipoprotein (LDL) by 14.2% (P < .001) and 6.6% (P < .01), respectively. These changes, apparent at 3 months, were maintained over 3 years. Serum triglyceride concentrations fell by 2.5% (P < .05) and 16.4% (P < .01), respectively. These decreases were evident after 6 months in both groups but were maintained over 3 years only in the transdermal group. High-density lipoprotein (HDL) concentrations fell in women given oral therapy (7.8%, P < .05) and transdermal therapy (10.7%, P < .001), as well as in untreated women (7.0%, P < .05).


CONCLUSIONS
The potentially beneficial effects of estrogen-progestin therapy on serum total and LDL cholesterol and on triglycerides were maintained over 3 years. Interpretation of the potentially detrimental effects on HDL concentrations was hindered by the changes seen in untreated women.
Whitcroft
S I
SI
Academic Department of Obstetrics and Gynaecology, King's College School of Medicine, London, England.
Crook
D
D
Marsh
M S
MS
Ellerington
M C
MC
Whitehead
M I
MI
Stevenson
J C
JC
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000527:Alprostadil / Q000097:blood; D001055:Apolipoproteins B / Q000187:drug effects*; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood / Q000187:drug effects; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D015232:Dinoprostone / Q000097:blood; D004958:Estradiol / Q000494:pharmacology; D015914:Estrogen Replacement Therapy / Q000379:methods; D004966:Estrogens, Conjugated (USP) / Q000494:pharmacology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009640:Norethindrone / Q000031:analogs & derivatives / Q000494:pharmacology; D000077563:Norethindrone Acetate; D009644:Norgestrel / Q000494:pharmacology; D017698:Postmenopause / Q000097:blood* / Q000187:drug effects*; D013997:Time Factors; D014280:Triglycerides / Q000097:blood*
D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004966:Estrogens, Conjugated (USP); D014280:Triglycerides; D009644:Norgestrel; D004958:Estradiol; D002784:Cholesterol; D000077563:Norethindrone Acetate; D000527:Alprostadil; D015232:Dinoprostone; D009640:Norethindrone