Transdermal hormone replacement therapy and Doppler findings in normal and overweight postmenopausal patients

Short-term effects of low-dose estradiol on endothelial function and blood viscosity in nondiabetic postmenopausal overweight women: a double-blind, placebo-controlled study

OBJECTIVE

The beneficial effects of estrogen on endothelial function depend on its integrity. This study evaluates the short-term effects of low-dose transdermal estradiol on endothelial function, insulin sensitivity, and blood viscosity in nondiabetic overweight/obese women.

METHODS

Forty-four nondiabetic overweight/obese women with a history of recent menopause were randomly allocated, in a double-blind fashion, to receive transdermal estradiol (1 mg/d, n = 22) or placebo (n = 22). The following parameters were assessed: endothelial reactivity (venous occlusion plethysmography and nailfold videocapillaroscopy), plasma levels of soluble adhesion molecules, insulin sensitivity (homeostasis model assessment of insulin resistance and areas under the curve of insulin and glucose during an oral glucose tolerance test), and blood and plasma viscosity. Data were expressed as means ± SD or medians [first to third quartiles].

RESULTS

Participants were aged 51.8 ± 2.3 years with a body mass index of 31.5 ± 2.5 kg/m and time since menopause was 3 [2-5] years. At baseline, no differences between the groups were observed; however, after 3 months of treatment, the following changes were observed in the estradiol group compared with the placebo group: a decrease in the forearm vascular resistance at baseline (36.37 [24.9-51.27] vs 51.3 [40.88-70.03] mm Hg/mL per min 100 mL tissue, P < 0.01) and during the postocclusive reactive hyperemia response (15.93 [11.32-22.29] vs 22.13 [16.46-29.7] mm Hg/mL per min 100 mL tissue, P < 0.01), and an increase in red blood cell velocity at rest (0.316 [0.309-0.326] vs 0.303 [0.293-0.308] mm/s, P < 0.001) and during postocclusive reactive hyperemia response (0.374 [0.353-0.376] vs 0.341 [0.333-0.355] mm/s, P < 0.001). Furthermore, blood viscosity was lower in the estradiol group than in the placebo group (3.57 ± 0.12 vs 3.76 ± 0.22 mPa.s; P < 0.01).

CONCLUSIONS

Short-term use of low-dose transdermal estradiol in nondiabetic overweight/obese women with a history of recent menopause improved endothelial function and decreased blood viscosity compared with placebo.

[Effects of transdermic estrogen therapy, isolated or in association with micronized progesterone, on clotting factors in overweight or normal postmenopausal women]

To evaluate HRT action over hemostasis we treated 45 postmenopausal women, divided in: Group 1 (N= 22, hysterectomized) and Group 2 (N= 23, with uterus), at the average age of 51.6 years and average BMI of 27.1 kg/m(2), with no significant difference in the base-line, with 17beta-oestradiol, 50 mcg/day, transdermic and continuous (group 1) associated to micronized progesterone 200 mg 12 days per month (group 2). The average of 2 samples of TAP, PTT, fibrinogen and platelet number was measured monthly during 3 months. For the total sample, there was a PTT shortening along treatment, from the second evaluation on (p= 0.006). Fibrinogen in Group 2 was significantly higher than in Group 1, from the second evaluation on (p= 0.0005). Patients with BMI > 25 presented a greater TAP shortening (p= 0.040) and a smaller fibrinogen drop (p= 0.033) than patients with BMI < 25. Prothrombotic effects predominated, especially in overweight women and in those who used progesterone.