Long-term Impacts of Oral Progestogen ( Medroxyprogestogen Acetate ) on the Levels of Serum Lipid and Lipoprotein durign Estrogen Replacement Therapy in Postmenopausal Women

Yoo, Kun Jae; Kim, Heung Yeol; Park, Un Dong

Abstract

Estrogen replacemetn therapy is known to reduce the incidence of cardio-ascular disease in postmenopausal women, and its beneficial effect is thought to be mediated in part by favorable changes in serum lipoprotien levels. However, the long-term effects on serum lipoproein levels of estrogen in low doses currently used have not been precisely evaluated in Korea. In postmenopausal women with uterus, progestogen should be added to protect the endometrium from the hyperplasia or carcinoma induced by unopposed estrogen. However, progestogens may adversely influence the beneficial effects of oral estrogen. To evaluate the impacts of progestogen on the lipid and lipoprotein levels during estrogen replacement therapy, we conducted the 1-year trial of conjugated equine estrogen(Premarine, 0.625mg/day) with or without cyclic prgoestogen(medroxy-progesterone acetate: MPA, 10mg/day for 12 days) in 120 postmenopausal women. Serum total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol levels in fasting state were measured in all subjects before treatment and at 12 months during treatment. The value of post-treatment levels were compared with that of baseline levels. In patients who received either premarine only or premarine plus MPA, serum HDL cholesterol levels increased significantly. While premarine plus MPA group showed a smaller increase in HDL cholesterol than premarine only group. And premarine plus MPA group showed a significant decrease in LDL cholesterol, total cholesterol, and triglyceride. While premarine only group showed a significant decrease in LDL cholesterol, but no statistical significance in total cholesterol and triglyceride levels. These results suggest that the addition of MPA at the daily dose of 10mg for 12 days cyclically in estrogen repalcement treatmetn appears to lessen the change to lipid and lipoprotein levels induced by unopposed estrogen, therefore maintain the longterm favorable effects on serum lipoprotein levels in postmenopausal women.