Papers

Randomised comparison of oestrogen versus oestrogen plus progestogen hormone replacement therapy in women with hysterectomy

^a

Correspondence to: Professor T W Meade, MRC Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, St Bartholomew's and the Royal London Hospital School of Medicine and Dentistry, London EC1M 6BQ.

Abstract

Objective: To compare the acceptability and symptomatic and metabolic effects of two regimens of hormone replacement therapy in women with hysterectomy.
Design: Randomised, double blind comparison.
Setting: Seven group practices in the Medical Research Council's general practice research framework.
Subjects: 321 women with hysterectomy aged 35-59.
Interventions: Hormone replacement therapy with (a) conjugated equine oestrogen 625 µg daily alone or (b) conjugated equine oestrogen 625 µg daily plus the progestogen norgestrel 150 µg daily for the last 12 days of the "cycle."
Main outcome measures: Changes in blood pressure, weight, symptoms, and haemostatic and lipid values.
Results: After two years 36% (57/158) of women randomly allocated to take oestrogen alone had discontinued treatment as compared with 30% (49/163) of women allocated to take oestrogen plus progestogen. Smokers were more likely to withdraw than non-smokers. There were no clear differences between the two groups in symptoms often attributed to hormone replacement therapy or in blood pressure or weight. At one year low density lipoprotein cholesterol concentrations had fallen substantially in both groups. High density lipoprotein cholesterol concentrations rose to significantly higher values in women taking oestrogen alone compared with those taking oestrogen plus progestogen, though triglyceride concentrations and factor VII activity were also significantly higher in this group. Fibrinogen concentration tended to fall, though not significantly, in both groups, possibly more in women taking oestrogen alone.
Conclusions: Oestrogen plus progestogen was no less well tolerated than oestrogen alone. There was a fairly even balance between possibly beneficial and adverse effects of the two regimens on lipid concentrations and coagulability. Concern that the combined regimen may not have the cardioprotective effects ascribed to oestrogen alone can to some extent be allayed, with reassurance for the growing numbers of women with intact uteri using the combined regimen. Misgivings about the combined regimen in women with hysterectomy on the grounds of its acceptability and its effects on lipid values may also be unfounded.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Article

Metabolic effects of hormone replacement preparations

Naveed Sattar, Chris J Packard, and Alan J Jaap
BMJ 1996 312: 1608. [Extract] [Full Text]

This article has been cited by other articles:

• Friedlander, A. H., Jones, L. J. (2002). The Biology, Medical Management, and Podiatric Implications of Menopause. J. Am. Podiatr. Med. Assoc. 92: 437-443 [Abstract] [Full text]  
• Sanders, T. A., Dean, T. S, Grainger, D., Miller, G. J, Wiseman, H. (2002). Moderate intakes of intact soy protein rich in isoflavones compared with ethanol-extracted soy protein increase HDL but do not influence transforming growth factor {beta}1 concentrations and hemostatic risk factors for coronary heart disease in healthy subjects. Am. J. Clin. Nutr. 76: 373-377 [Abstract] [Full text]  
• Rymer, J., Morris, E. P (2000). Extracts from "Clinical Evidence": Menopausal symptoms. BMJ 321: 1516-1519 [Abstract] [Full text]  
• Edmunds, E., Landray, M., Lip, G. Y.H. (2000). Hormone Replacement Therapy and Intima-Media Thickness of the Common Carotid Artery: The Rotterdam Study. Stroke 31 : i-2278 [Full text]  
• Grady, D., Wenger, N. K., Herrington, D., Khan, S., Furberg, C., Hunninghake, D., Vittinghoff, E., Hulley, S., for the Heart and Estrogen/progestin Replacement S, (2000). Postmenopausal Hormone Therapy Increases Risk for Venous Thromboembolic Disease: The Heart and Estrogen/progestin Replacement Study. ANN INTERN MED 132: 689-696 [Abstract] [Full text]  
• EDMUNDS, E., LIP, G.Y.H. (2000). Cardiovascular risk in women: the cardiologist's perspective. QJM 93: 135-145 [Full text]  
• de Valk-de Roo, G. W., Stehouwer, C. D.A., Meijer, P., Mijatovic, V., Kluft, C., Kenemans, P., Cohen, F., Watts, S., Netelenbos, C. (1999). Both Raloxifene and Estrogen Reduce Major Cardiovascular Risk Factors in Healthy Postmenopausal Women : A 2-Year, Placebo-Controlled Study. Arterioscler. Thromb. Vasc. Bio. 19: 2993-3000 [Abstract] [Full text]  
• Brehme, U., Bruck, B., Gugel, N., Wehrmann, M., Hanke, S., Finking, G., Schmahl, F. W., Hanke, H. (1999). Aortic Plaque Size and Endometrial Response in Cholesterol-Fed Rabbits Treated With Estrogen Plus Continuous or Sequential Progestin. Arterioscler. Thromb. Vasc. Bio. 19: 1930-1937 [Abstract] [Full text]  
• Rossouw, J. E. (1999). Does Estrogen Have a Role in the Prevention of Cardiovascular Disease?. J. Clin. Endocrinol. Metab. 84: 1806-1810 [Full text]  
• Welton, A J, Vickers, M R, Cooper, J A, Meade, T W, Marteau, T M (1999). Is recruitment more difficult with a placebo arm in randomised controlled trials? A quasirandomised, interview based study. BMJ 318: 1114-1117 [Abstract] [Full text]  
• Sbarouni, E., Kyriakides, Z. S., Kremastinos, D. T. (1998). The effect of hormone replacement therapy alone and in combination with simvastatin on plasma lipids of hypercholesterolemic postmenopausal women with coronary artery disease. J Am Coll Cardiol 32: 1244-1250 [Abstract] [Full text]  
• Sudhir, K., Chou, T. M., Chatterjee, K., Smith, E. P., Williams, T. C., Kane, J. P., Malloy, M. J., Korach, K. S., Rubanyi, G. M. (1997). Premature Coronary Artery Disease Associated With a Disruptive Mutation in the Estrogen Receptor Gene in a Man. Circulation 96: 3774-3777 [Abstract] [Full text]  
• Scarabin, P.-Y., Alhenc-Gelas, M., Plu-Bureau, G., Taisne, P., Agher, R., Aiach, M. (1997). Effects of Oral and Transdermal Estrogen/Progesterone Regimens on Blood Coagulation and Fibrinolysis in Postmenopausal Women : A Randomized Controlled Trial. Arterioscler. Thromb. Vasc. Bio. 17: 3071-3078 [Abstract] [Full text]  
• Col, N. F., Eckman, M. H., Karas, R. H., Pauker, S. G., Goldberg, R. J., Ross, E. M., Orr, R. K., Wong, J. B. (1997). Patient-Specific Decisions About Hormone Replacement Therapy in Postmenopausal Women. JAMA 277: 1140-1147 [Abstract]  
• Rossouw, J. E. (1996). Estrogens for Prevention of Coronary Heart Disease: Putting the Brakes on the Bandwagon. Circulation 94: 2982-2985 [Full text]  
• Sattar, N., Packard, C. J, Jaap, A. J (1996). Metabolic effects of hormone replacement preparations. BMJ 312: 1608-1608 [Full text]  
• (1996). ADDING PROGESTERONE TO ESTROGEN OK FOR THE HEART. JWatch General 1996: 5-5 [Full text]