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A randomised comparison of the effects of oral versus transdermal 17β‐oestradiol, each combined with sequential oral norethisterone acetate, on serum lipoprotein levels
Author(s) -
Spencer Chris,
Crook David,
Ross David,
Cooper Alison,
Whitehead Malcolm,
Stevenson John
Publication year - 1999
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1999.tb08435.x
Subject(s) - norethisterone , transdermal , norethisterone acetate , medicine , pharmacology , endocrinology , estrogen , population , research methodology , environmental health
Objective To investigate the effects of oral versus , transdermal 17β‐oestradiol, given in both cases with sequential addition of oral norethisterone acetate, on serum lipid and lipoprotein levels in postmenopausal women. Design Open, randomised, parallel groups study. Setting University Clinical Research Group. Population Sixty‐four postmenopausal women with climacteric complaints who were otherwise healthy were screened. Of these, 58 fulfilled the entry criteria. Methods Fifty‐eight postmenopausal women were randomised to receive either oral 17β‐oestradiol/oestriol (Trisequens) or transdermal 17β‐oestradiol (Estrapak) together with cyclical addition of norethisterone acetate for 48 weeks. Main outcome measures Serum levels of total cholesterol, triglycerides, high density lipoproteins (HDL), low density lipoproteins (LDL), very low density lipoproteins (VLDL), apolipoproteins, and lipoprotein(a) at baseline, and after 46 weeks (oestrogen‐alone phase), and 48 weeks (oestrogen‐progestogen phase) of treatment. Results Oral oestradiol therapy did not affect serum total cholesterol levels during the oestrogen‐alone phase, but during the combined phase there was a 5% fall ( P < 0.05 ) due to a 7% decrease in LDL cholesterol levels ( P < 0.01 ). Oral therapy also increased serum triglyceride levels by 9.4% during the oestrogen‐alone phase ( P < 0.05 ). During the combined phase of transdermal therapy, there was a 19% fall in serum triglyceride levels ( P < 0.05 ) and a 6%, fall in HDL levels ( P < 0.05 ). Oral oestradiol reduced lipoprotein(a) levels by 31% during the oestrogen‐alone phase and by 37% with norethisterone acetate addition ( P < 0.05 ). Transdermal therapy had no significant effect on lipoprotein(a). Conclusions Other than a minor fall in HDL, in women receiving transdermal 17β‐oestradiol, co‐administration of oral progestogen in general improved, rather than worsened, this serum lipoprotein profile.