SEX-HORMONE BINDING GLOBULIN AS AN INDICATOR OF THE HEPATIC IMPACTS OF CONTINUOUS COMBINED HORMONE REPLACEMENT REGIMENS

Objectives: Nonoral administration of hormone replacement therapy avoi ds the first pass metabolism of steroids in the liver. We wanted to de termine to what extent it has an effect on the serum concentrations of sex-hormone binding globulin and the free testosterone index. Methods : Postmenopausal women received 50 mu g per day transdermal estradiol associated with the use of a levonorgestrel-releasing intrauterine dev ice (20 women) or a daily oral dose of 2 mg of estradiol and 1 mg of n orethisterone acetate (20 women) for 1 year. Eight women, five in the nonoral and three in the oral therapy group discontinued the study. Re sults: Although serum sex-hormone binding globulin concentrations decr eased in women receiving transdermal estradiol in combination with a l evonorgestrel-releasing intrauterine device, the free testosterone ind ex did not change significantly. In the continuous oral regimen, no si gnificant changes in serum sex-hormone binding globulin or free testos terone index were observed. The free testosterone index, however, was significantly higher in the nonoral therapy group after 6 and 12 month s of treatment than in the oral therapy group. Conclusions: Continuous progestin combined with continuous estrogen in oral and nonoral repla cement therapy does not lead to a substantial androgenic excess in pos tmenopausal women. The intrauterine administration of levonorgestrel a ppears to have some hepatic effect. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.