Comparative effects of estrogens plus androgens and tibolone on bone, lipid pattern and sexuality in postmenopausal women.
BACKGROUND
The main goals of estrogen replacement therapy (ERT) are the prevention of osteoporosis and cardioprotection and the improvement of quality of life (QL). Androgens and tibolone therapy may increase bone mineral density (BMD) to a greater extent than ERT and offer an increase in QL. Lipid and cardiovascular effects, however, are still a major concern.


OBJECTIVE
To evaluate whether the addition of a weak androgen to ERT may improve postmenopausal bone loss and sexual activity without adverse effects on lipid pattern and to compare these effects with those observed after tibolone therapy.


METHODS
This prospective study enrolled 120 surgical postmenopausal women; of these, 96 completed the 1-year follow-up. Patients were allocated to one of four groups. The first group (A; n = 23) received 4 mg of estradiol valerate plus 200 mg of enanthate of dihydroandrosterone im monthly. The second group (E; n = 26) received 50 microg/day of transdermal 17-b-estradiol continuously; the third (T; n = 23) received 2.5 mg of tibolone every day; and finally, the fourth group (C; n = 24) constituted a treatment-free control group. Bone mass (dual X-ray absorptiometry), serum total cholesterol, HDL, LDL, triglycerides, apolipoproteins A1 and B and sexual activity were evaluated before starting therapy and at the end of follow-up.


RESULTS
All active treatment groups showed an increase in BMD. This increase was higher in the A treatment group (4.08% P < 0.01). Sexuality improved significantly with therapy; however, tibolone and androgens increased scores to a greater extent than ERT. Androgen therapy was associated with significant increases in total cholesterol, LDL and triglycerides. Cholesterol and LDL fall into groups E and T, HDL into groups A and T and triglycerides in group T only.


CONCLUSIONS
The combined regimen of androgens and ERT increased vertebral bone mass and enhance sexual activity in postmenopausal women equal to that of tibolone and to a greater extent than ERT alone; its effects on lipids, however, are clearly adverse.
Castelo-Branco
C
C
Department of Gynaecology and Obstetrics, Hospital Clínic i Provincial de Barcelona, Spain.
Vicente
J J
JJ
Figueras
F
F
Sanjuan
A
A
Martínez de Osaba
M J
MJ
Casals
E
E
Pons
F
F
Balasch
J
J
Vanrell
J A
JA
D000279:Administration, Cutaneous; D045930:Anabolic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016632:Apolipoprotein A-I / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D015519:Bone Density / Q000187:drug effects; D001842:Bone and Bones / Q000187:drug effects*; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003687:Dehydroepiandrosterone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008055:Lipids / Q000097:blood*; D008875:Middle Aged; D009652:Norpregnenes / Q000008:administration & dosage / Q000627:therapeutic use*; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy; D017698:Postmenopause / Q000187:drug effects*; D011446:Prospective Studies; D019529:Sexuality / Q000187:drug effects*; D014280:Triglycerides / Q000097:blood
D045930:Anabolic Agents; D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004966:Estrogens, Conjugated (USP); D008055:Lipids; D009652:Norpregnenes; D014280:Triglycerides; C033624:dehydroepiandrosterone enanthate; D003687:Dehydroepiandrosterone; D004958:Estradiol; D002784:Cholesterol; C027385:tibolone