Table 4.
Lipid metabolism: features of studies comparing oral and transdermal hormone replacement therapy
| Author, year | Study type | Compared groups | Results | |
|---|---|---|---|---|
| Perrone G et al. 1996 | Randomized controlled trial |
Group 1 (N = 14) t-E2 50 mcg + MPA 10 mg/day Group 2 (N = 14) o-E2 0.625 mg/day + MPA 10 mg/day Group 3: never-use HRT (N = 14) |
Total cholesterol and LDL cholesterol decreased after 6 months in both reported groups Small variations of HDL cholesterol and triglycerides were reported |
|
| Adami S et al. 1993 | Randomized controlled trial |
Group 1 o-E2 0.625 mg/MPA 10 mg/12 days Group 2 (N = 27): t-E2 patch 0.05 mg/MPA 10 mg/12 days Group 3: never-use HRT |
LDL diminished with estrogen replacement therapy HDL diminished with t-E2 and slightly increase with O-E2 Triglycerides diminished with t-E2 and slightly increased with O-E2 |
|
| Whitcroft SI et al. 1994 | Randomized controlled trial |
Group 1 o-CEE 0.625 mg/dinorgestrol 0.15 mg/12 days Group 2 t-E2 patch 0.05 mg/NETA 0.25 mg/14 days Group 3: never-use HRT |
o-CEE Total cholesterol decreased by 12.1% (p < 0.001) LDL levels decreased by 14.2% (p < 0.001) HDL decreased by 7.8% (p < 0.05) Triglycerides decreased by 2.5% (p < 0.05) and t-E2-16.4% (p < 0.01) T-E2 Total cholesterol decreased by 8.4% (p < 0.001) LDL levels decreased by 6.6% (p < 0.01) HDL decreased by 10.7%, (p < 0.001) Triglycerides decreased by 16.4% (p < 0.01) The potentially beneficial effects of estrogen–progestin therapy on serum total and LDL cholesterol and on triglycerides were maintained over 3 years |
|
| Spencer C et al. 1999 | Randomized controlled trial |
Group 1 o-E2 2 mg/1 mg/NETA 1 mg Group 2 t-E2patch 0.05 mg/NETA 1 mg |
O-E2 Total cholesterol decreased by 7% (p < 0.001) LDL levels increased by 3% (p < 0.001) HDL decreased by 3% (p < 0.05) Triglycerides increased by 9.4% (p < 0.05) T-E2 Total cholesterol decreased by 4% (p < 0.001) HDL decreased by 6%, (p < 0.001) Triglycerides decreased by 19% (p < 0.05) |
|
| Erneus M et al. 2001 | Randomized controlled trial |
Group 1 o-CEE 0.625 mg/MPA 2.5 mg Group 2 t-E2patch0.05 mg/MPA 2.5 mg |
o-CEE Total cholesterol decreased by 1,9% (p < 0.001) after 1 year and by14.7% after 2 years LDL levels increased by 3% (p < 0.001) HDL decreased by 10.2% (p < 0.05) and by 31.4% after 2 years Triglycerides increased by 9.4% (p < 0.05) T-E2 Total cholesterol decreased by 6.2% (p < 0.001) after 1 year and 18% after 2 years HDL decreased by 13.5%, (p < 0.001) after 1 year and 33.6% after 2 years Triglycerides decreased by 33.7% (p < 0.05) |
|
| Araujo DA et al. 2002 | Randomized controlled trial |
Group 1 o-CEE 0.625 mg/micronized progesterone 300 mg/12 days Group 2 t-E2patch 0.05 mg/micronized P4 300 mg/12 days |
o-CEE HDL and triglycerides significantly increased (9% and 20.7%, p = 0.04) Total cholesterol and LDL values did not change T-E2 Not statistically significant changes in lipid composition |
|
| Wakatsuki A et al. 2002 | Randomized controlled trial |
Group 1 o-CEE 0.625 mg Group 2 t-E2 patch 0.05 mg Group 3: never-use HRT |
O-E2 Total cholesterol decreased LDL lower after treatment HDL significantly increased Triglycerides higher after treatment T-E2 Total cholesterol decreased Triglycerides significantly decreased HDL values did not change with treatment The use of transdermal estrogen, but not oral, leads to larger LDL particles more resistant to oxidation, preserving the estrogen’s antioxidizing effect |
|
| Nanda S et al. 2003 | Randomized controlled trial |
Group 1: HRT o-CEE 0.625 mg t-E2 patch 0.05 mg Group 2: never-use HRT |
O-E2 Total cholesterol decreased by 7% (p < 0.001) after 7 months LDL levels decreased by 22% after 6 months Triglycerides increased by 8% (p < 0.01) T-E2 Total cholesterol decreased by 2% (p < 0.001) after 7 months LDL levels decreased by 16% after 6 months Triglycerides decreased by 6% (p < 0.05) |
|
| Sanada M et al. 2004 | Randomized controlled trial |
Group 1 o-CEE 0.625 mg/MPA 2.5 mg Group 2: after 12 months of o-E2 t-E2 patch 0.05 mg/MPA 2.5 mg |
O-E2 Total cholesterol decreased by 1,9% (p < 0.001) after 1 year and by14.7% after 2 years Ratio of LDL and Apo-B decreased by 12.8%, (p < 0.05) HDL decreased by 2,6% (p < 0.05) Triglycerides increased by 78% (p < 0.05) T-E2 Total cholesterol decreased by 6.2% (p < 0.001) after 1 year and 18% after 2 years Ratio of LDL and Apo-B increased significantly (p < 0.05) LDL increased 4.8% HDL decreased by and additional 3.9%, Triglycerides decreased by 51% (p < 0.05) |
|
| Shakir YA et al. 2004 | Randomized controlled trial |
Group 1 0.05 mg/sequential NETA 0.25 mg 15–28. day Group 2 Oral E2 2 mg/1 mg/continuous NETA 1 mg Group 3 Oral E2 0.05 mg/sequential NETA 1 mg 23.-28.day |
Total cholesterol higher with t-E2 compared to both o-E2 regimens (5.9 vs 5.68, p < 0.05) LDL no statistically significant differences in reported groups HDL no statistically significant differences in reported groups Triglycerides no statistically significant differences in reported groups |
|
| Vrablik M et al., 2008 | Randomized controlled trial |
Group 1 o-E2 2 mg Group 2 t-E2 patch 0.05 mg |
O-E2 Total cholesterol decreased by 4% (p < 0.01) LDL levels decreased by 19% (p < 0.001) HDL increased by 10.5% (p < 0.01) and by 31.4% after 2 years Triglycerides increased by 14% (p < 0.01) T-E2 Total cholesterol values did not change LDL levels decreased by 3,2% (p < 0.001) HDL increased by 5,2%, (p < 0.001) after 1 year and 33.6% after 2 years Triglycerides, no significant changes The atherogenic plasma index significantly reduced relative to o-E2 (-0.17 vs -0.23, P = 0.023) |
|
| Lee JY et al., 2015 | Cohort study |
Group 1 o-CEE 0.625 mg/micronized P4200 mg Group 2 t-E2 0.1% 1.5 mg/micronized P4 200 mg |
O-E2 Decreased LDL (P = 0.001) and elevated triglycerides (P = 0.007) and HDL (P = 0.001) T-E2 Decreased LDL and increase of triglycerides and HDL, although statistically insignificant. Triglycerides remained unchanged |
HRT hormone replacement therapy, o-CEE conjugated equine estrogens, LDL low-density lipoprotein, HDL high-density lipoprotein, MPA medroxyprogesterone acetate, NETA norethindrone acetate