Changes of Lipoprotein Profile in Postmenopausal Women Receiving Hormone Replacement Therapy: Effects of Natural Progesterone and Synthetic Progesterone

陳芳萍醫師

　
■OBJECTIVE

To compare the effects of medroxyprogesterone acetate and 
micronized progesterone on the lipid profile of postmenopausal women receiving 
conjugated equine estrogen. 
■STUDY DESIGN

 A prospective, clinical study of the changes in lipoprotein profile evaluated in 123 postmenopausal women, receiving conjugated estrogen alone (group I) and conjugated estrogen combined with medroxyprogesterone acetate (group II) or micronized progesterone (group III) respectively, before treatment and 6 months after treatment. 
■RESULTS

Group I had significantly increased HDL-C levels (14.4%) after 6 months, as well as decreased LDL-C concentrations (-6.61%), LDL/HDL and total cholesterol/HDL-C ratios (p<0.05). In group II and III, HDL-C concentrations increased 4.58% and 5.44%, respectively, after 6 months. LDL-C levels were markedly decreased in group II (8.98%). There was no significant reduction of LDL-C levels in group III. Total cholesterol levels were significantly decreased only in group II (-4.93%). Triglyceride levels were increased with statistical significance only in group III (21.2%, p<0.05). LDL/HDL and total cholesterol/HDL-C ratios were significantly decreased in group II, and this effect was more pronounced in group I. There was no change in the ratios in group III.
■CONCLUSION

Conjugated estrogen replacement therapy had a persistent cardioprotective effect in postmenopausal women, based on the positive effect to lipoprotein metabolism. Both natural and synthetic progesterones blunt the beneficial effects of estrogen on the lipoprotein profile, and micronized progesterone is not superior to medroxyprogesterone acetate.

　
Table I. Clinical data of the three hormone replacement therapy groups 

Group#

Age (y)

Period of Menopause (y)

Body height (cm)

Body Weight (kg)

Gr. I

50.56+6.75

(40~63)

4.02+4.70

(1~12)

152.84+4.76

(144~167)

55.98+6.65

(42~73)

Gr. II

52.21+5.98

(40~63)

4.09+4.29

(1~12)

152.13+5.22

(142~163)

56.06+6.84

(44~71)

Gr. III

53.38+4.79

(42~61)

4.46+4.25

(1~12)

152.79+6.27

(142~167)

56.69+8.03

(44~74)

# Group I : patients with conjugated estrogen only
   Group II : patients with estrogen plus medroxyprogesterone acetate
   Group III : patients with estrogen plus micronized progesterone
* There were no statistically significant differences among these 3 groups.
Table II   Changes in lipoprotein profile ( mean + SD and range ) before treatment and 6 months after treatment

Groups

 

 

 

            I      

            II      

            III      

 

 

 

before

after

before

after

before

after

 

Total cholesterol (mg %)

 

224.95+45.14

(372~143)

220.27+35.85

(325~150)

218.74+33.84

(305~157)

206.58+34.1+

(299~147)

220.90+40.24

(317~135)

214.92+35.53

(307~133)

 

Triglyceride

(mg %)

99.19+53.57

(301~31)

107.0+55.11

(294~33)

101.44+57.28

(255~32)

98.46+50.61

(238~26)

84.18+37.77

(218~38)

96.13+40.31@

(207~34)

 

HDL (mg %)

 

56.88+16.66

(94~30)

63.0+18.88*

(116~30)

58.72+13.20

(87~34)

60.67+16.07

(116~32)

61.69+13.62

(87~30)

62.97+15.36

(102~38)

 

VLDL (mg %)

 

18.98+10.61

(60~6)

21.46+11.09

(58~6)

19.86+11.50

(51~6)

19.26+10.01

(47~7)

16.41+7.57

(43~7)

18.36+8.58

(41~6)

 

LDL (mg %)

 

149.10+44.91

(296~76)

135.80+34.11*

(219~65)

141.56+31.33

(193~89)

126.65+29.67+

(190~70)

142.79+40.66

(230~48)

133.15+33.12

(233~70)

 

CH/HDL

 

4.25+1.35

(7.82~2.01)

3.77+1.20*

(7.76~2.0)

3.89+0.97

(7.0~2.26)

3.60+0.98+

(6.11~2.13)

3.8+1.24

(7.2~1.73)

3.59+1.0

(6.04~2.23)

 

LDL/HDL

 

2.86+1.2

(6.12~0.87)

2.37+1.03*

(4.51~0.86)

2.54+0.83

(5.20~1.16)

2.24+0.83+

(4.66~1.01)

2.5+1.08

(4.73~0.61)

2.27+0.87

(4.66~0.92)

＊      P＜0.05    ＋      P＜0.05    @       P＜0.05    #Numbers in parentheses represent range.