HORMONAL REPLACEMENT THERAPY AND LIPIDS - IS TRANSDERMAL NORETHISTERONE ACETATE BETTER THAN ORAL MEDROXYPROGESTERONE ACETATE

We evaluated the effect of transdermal norethisterone acetate (NETA) v ersus oral medroxyprogesterone acetate (MPA) on the lipids of 28 postm enopausal women taking hormonal replacement therapy for climacteric sy mptoms. All the 28 patients were using conventional patches releasing 0.050 mg of estradiol per day continuously. However, while one group o f 14 patients received transdermal NETA (0.25 mg/day) for 14 days of t he cycle, the other group of 14 patients received oral MPA (10 mg/day) for the same number of days. The patients were randomly allocated to one of the two groups. The treatment cycles were repeated for 12 month s. There was no significant difference between the two treatment group s for compliance and for incidence of side effects. Both hormonal repl acement therapies were equally effective in relieving climacteric symp toms. All the patients underwent serum lipid assays twice, the first t ime before starting treatment and then again during the progestogen ph ase of the 12th and last cycle. Serum total cholesterol (TC), law-dens ity lipoprotein (LDL-C), and triglyceride levels did not change signif icantly during both treatments. Transdermal estradiol associated with oral MPA significantly reduced high-density lipoprotein (HDL-C) by 17. 9% (p < 0.05) and significantly increased LDL-C/HDL-C and TC/HDL-C ris k ratios by 61.7% (p < 0.05) and 33.1% (p < 0.05), respectively. In co ntrast, administration of the transdermal NETA did not significantly a ffect HDL-C levels (- 1.9% of decrease) and, consequently, the risk ra tios were minimally altered, with 3.3 and 6.0% increases for TC/HDL-C and LDL-C/HDL-C, respectively. There was a statistically significant d ifference (p < 0.05) in HDL-C net changes between MPA and NETA treatme nts (+ 8.5 and - 8.0 mg/dl, respectively). We can therefore conclude t hat the association of transdermal NETA with transdermal estradiol eli cits a relatively benign impact on lipoprotein profile in comparison t o oral MPA association.