Comparative effects of estrogens plus androgens and tibolone on bone, lipid pattern and sexuality in postmenopausal women

Background: The main goals of estrogen replacement therapy (ERT) are the pr evention of osteoporosis and cardioprotection and the improvement of qualit y of life (QL). Androgens and tibolone therapy may increase bone mineral de nsity (BMD) to a greater extent than ERT and offer an increase in QL. Lipid and cardiovascular effects, however, are still a major concern. Aim: To ev aluate whether the addition of a weak androgen to ERT may improve postmenop ausal bone loss and sexual activity without adverse effects on lipid patter n and to compare these effects with those observed after tibolone therapy. Subjects ann methods: This prospective study enrolled 120 surgical postmeno pausal women; of these, 96 completed the 1-year follow-up. Patients were al located to one of four groups. The first group (A; n = 23) received 4 mg of estradiol valerate plus 200 mg of enanthate of dihydroandrosterone im mont hly. The second group (E; n = 26) received 50 mu g/day of transdermal 17-b- estradiol continuously; the third (T; n = 23) received 2.5 mg of tibolone e very day; and finally, the forth group (C; n = 24) constituted a treatment- free control group. Bone mass (dual X-ray absorptiometry), serum total chol esterol, HDL, LDL, triglycerides, apolipoproteins Al and B and sexual activ ity were evaluated before starting therapy and at the end of follow-up. Res ults: All active treatment groups showed an increase in BMD. This increase was higher in the A treatment group (4.08% P<0.01). Sexuality improved sign ificantly with therapy; however, tibolone and androgens increased scores to a greater extent than ERT. Androgen therapy was associated with significan t increases in total cholesterol, LDL and triglycerides. Cholesterol and LD L fail into groups E and T, HDL into groups A and T and triglycerides in gr oup T only. Conchsion: The combined regimen of androgens and ERT increased vertebral bone mass and enhance sexual activity in postmenopausal women equ al to that of tibolone and to a greater extent than ERT alone; its effects on lipids, however, are clearly adverse. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.