The effects of estrogen therapy and estrogen combined with different androgenic progestins on carbohydrate and lipid metabolism in overweight-obese younger postmenopausal women

Objective. The aim of the present study was to compare the effect of three different progestins with differing androgenicity on carbohydrate and lipid metabolism in overweight-obese younger postmenopausal women. Additionally, the relationship between testosterone and insulin resistance was assessed. Methods. The study included 125 postmenopausal women. Estradiol (E2) 2 mg day was given to 20 hysterectomized women and the remaining 105 women were randomized into three treatment groups: E2 2 mg day plus dienogest 2 mg day (n=35); E2 2 mg day plus norethisterone acetate (NETA) 1 mg day (n=35); E2 2 mg day plus medroxyprogesterone acetate (MPA) 2.5 mg day (n=35). A 75-g oral glucose tolerance test was performed at the initial and 3-month visit. Serum glucose, insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides were measured before and after treatment. Results. A significant treatment-related increase was observed only in the E2 MPA group for insulin resistance (p=0.031). When the change in the insulin glucose ratio was compared, the E2 group was significantly different from the E2 MPA and E2 NETA groups (p=0.008 and 0.02, respectively). Only the E2 dienogest group showed a treatment-related increase in fasting glucose level (p=0.037). A decrease in total cholesterol and LDL-C levels was observed in all groups (p=0.004 and 0.012, respectively). The only significant decrease in HDL-C level was observed in the E2 NETA group (p=0.005). Conclusion. Estrogen therapy had a positive effect on carbohydrate and lipid metabolism in overweight-obese postmenopausal women. The addition of progestin to estrogen therapy attenuated estrogen's positive effects slightly; however, the biological actions of the three different androgenic progestins used did not result in any variation.