Short-term effects of two continuous combined oestrogen–progestogen therapies on several cardiovascular risk markers in healthy postmenopausal women: A randomised controlled trial

Objective

To compare the short-term effects of two oral continuous combined oestrogen–progestogen treatment regimens on blood concentrations of several cardiovascular risk markers in healthy postmenopausal women.

Study design

In a 12-week randomised controlled study, 48 healthy non-hysterectomised postmenopausal women, aged 41–58 years, received either no treatment (control group; n = 16), or daily oral continuous combined treatment with 1 mg micronised 17β-oestradiol plus 5 mg dydrogesterone (E/D group; n = 18) or 0.625 mg conjugated equine oestrogens plus 5 mg medroxyprogesterone acetate (CEE/MPA group; n = 14).Fasting blood sampling was performed at baseline and after 12 weeks of follow-up.

Results

Compared with the control group, 12-week treatment with E/D or CEE/MPA reduced fibrinogen (−7.7%, p = 0.004 and −3.3%, p = 0.083, respectively), factor VII-act (−8.7%, p = 0.14 and −9.7%, p = 0.06, respectively), homocysteine (−20.5%, p = 0.02 and −26.7%, p = 0.005, respectively), and IGF-1 (−27.9%, p < 0.001 and −18.1%, p = 0.002, respectively), but increased factor VII-ag (+10.1%, p = 0.03 and +4.4%, p = 0.46, respectively), endothelin-1 (+15.2%, p = 0.12 and +20.0%, p = 0.13, respectively) and C-reactive protein (+88.8%, p = 0.18 and +71.0%, p = 0.44, respectively). Fibrinolytic factors were not affected by either hormone therapy (HT).

Conclusions

Short-term oral continuous combined therapy with oestradiol/dydrogesterone and conjugated equine oestrogens/medroxyprogesterone acetate had comparable effects on the investigated cardiovascular risk markers.     

A new combination of conjugated equine oestrogens and medroxyprogesterone for treatment of climacteric complaints

Thirty-four post-menopausal women with climacteric complaints were given conjugated equine oestrogens (1.25 mg/day) for 21 days followed by 2 days without hormones and then 5 mg medroxyprogesteroneacetate daily for 5 days. The present trial was designed to study effects on vasomotor symptoms, bleeding patterns and endometrial histopathology. Vasomotor disturbances were completely relieved. No recurrence of symptoms was recorded in the oestrogen-free week. Withdrawal bleedings were regular and slight, which was a positive experience for those women who had previously been treated with other oestrogen-progestogen regimens. In most patients inactive or weak secretory endometrial epithelium was found during treatment. Two women developed differing degrees of hyperplasia after 2.5 and 3 yr, respectively. This fact emphasizes the necessity of adding progestogens for at least 10 days each month even if the oestrogens and progestogens are administered separately. It may also be wise to perform an endometrial biopsy when sex hormones are administered on a long-term basis.