CYCLIC GESTAGEN ADDITION (MPA) FOR CONTIN UAL TRANSDERMAL OR PERORAL ESTROGEN SUBSTITUTION IN POSTMENOPAUSE - IN FLUENCE EXERCISED ON SERUM-LIPIDS

Since postmenopause unopposed oestrogen replacement therapy (ERT) incr eases the incidence of endometrial carcinoma, the addition of a proges tin in non-hysterectomised women is mandatory for hormonal substitutio n. On the other hand, progestins have a negative influence on serum li pids and may thus put in question the benefits of the ERT with regard to the cardiovascular risk. Progestins lower HDL and increase LDL in a dose-dependent way according to their chemical structure. In the pres ent non-randomised study, the influence of a cyclic combined oestrogen progestin substitution on the serum lipids has been measured. From a total of 90 apparently healthy postmenopausal patients, 59 received a transdermal ERT with 17beta-Estradiol (Estraderm(R) TTS 50), whereas 3 1 women obtained a daily dose of 0.625 mg conjugated equine oestrogens (CE) perorally. Additionally all patients were given 10 mg medroxy-Pr ogesterone-acetat (MPA) daily during the first 10 days of each month. After 6 months of therapy, the following changes of serum lipids, expr essed as percentage of initial values, were measured: total cholestero l in the transdermal group -2.3 % (n. s.), in the peroral group - 11.8 % (p < 0.00001); triglycerides - 3.7 % (n. s.) resp. +8.6 % (n. s.); HDL cholesterol + 0.2 % (n. s.) resp. - 1.8 % (n. s.); LDL cholesterol + 1.3 % (n. s.) resp. - 14.8 % (p < 0.00001). The calculated antherog enic indices showed a decrease in the peroral substituted group of - 6 .5 % (n. s.) for the HDL/total cholesterol ratio and - 14,8 % (p < 0.0 02) for the LDL/HDL ratio. In the cyclic combination with MPA peroral ERT with 0.625 mg CE daily seems superior to the transdermal applicati on of 50 mcg 17-beta-estradiol in respect of the serum-lipid changes.