Beneficial effects on serum lipoproteins by 17β-oestradiol-dydrogesterone therapy in postmenopausal women; a prospective study

Study objective: To study the possible changes of reproductive hormones, sex hormone binding globulin, serum lipids and lipoproteins, lipoprotein (a) included, coagulation and glucose in postmenopausal women treated with 17β-oestradiol and cyclic dydrogesterone for 14 days per 28 days treatment cycle. Design: Open longitudinal prospective study. Duration: Twelve 28 days treatment cycles. Setting: Gynaecological department of university hospital. Subjects: 27 healthy postmenopausal women. Results: After treatment for six cycles serum concentrations of FSH and LH decreased significantly with 43.0% and 24.4%, respectively. Serum concentrations of 17β-oestradiol and oestrone increased significantly with 302% and 792%, respectively, and SHBG increased as well with 111% ( P < 0.01). Serum total cholesterol decreased with 9.0% ( P < 0.01). Serum VLDL-cholesterol did not change significantly. Serum LDL-cholesterol decreased with 16.3% ( P < 0.01) and HDL-cholesterol increased with 8.0% ( P < 0.01). This was accompagnied with similar significant changes in the apolipoproteins: apolipoprotein A-I rose with 14.4% and apolipoprotein B decreased with 6.0%. Serum triglycerides and VLDL-triglycerides increased significantly with 14.4% and 17.9%, respectively. Lipoprotein (a) decreased with 17.5% ( P < 0.01). These results more or less sustained at cycle 12 of treatment. Serum concentrations of antithrombin III and glucose did not change. Fibrinogen decreased slightly but significantly below the initial value. Conclusions: This combination replacement therapy gives beneficial changes in lipidmetabolism, indicating a reduced risk of developing coronary heart disease without unfavourably changing coagulation and glucose metabolism. The expected beneficial changes with oestradiol alone are not counteracted by the intermittent addition of dydrogesterone. Therefore this oestrogen/progestagen scheme can, indeed, be recommended for use in HRT.