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Moshe S. Weintraub, MD; Itamar Grosskopf, MD; Gideon Charach, MD; Nachman Eckstein, MD; Yehuda Ringel, MD; Nitsan Maharshak, MD; Heschi H. Rotmensch, MD; Ardon Rubinstein, MD

Arch Intern Med. 1998;158:1803-1806.

Background  Fluctuations in lipid and lipoprotein levels are encountered quite often in hyperlipidemic patients. We examined the possibility that lipid and lipoprotein levels fluctuate due to the different effects of estrogen and progestogen in postmenopausal hyperlipidemic women receiving combined hormonal replacement therapy.

Methods  In an open-label study conducted during 3 consecutive hormonal cycles (3 months), levels of fasting total cholesterol, triglycerides, and low (LDLC)- and high-density lipoprotein cholesterol (HDLC) were determined in 36 postmenopausal hyperlipidemic women on day 13 of conjugated equine estrogen (1.25 mg/d) therapy and on day 25 after 12 days of receiving estrogen plus medroxyprogesterone acetate (5 mg/d).

Results  While receiving estrogen and combined therapies, means ± SD total cholesterol levels increased from 6.50 ± 0.97 mmol/L (251 ± 37 mg/dL) to 6.88 ± 1.42 mmol/L (266 ± 54 mg/dL) (P<.001); LDLC levels, from 4.05 ± 1.14 mmol/L (156 ± 44 mg/dL) to 4.62 ± 1.36 mmol/L (178 ± 52 mg/dL) (P<.001). Mean ± SD HDLC cholesterol levels decreased from 1.44 ± 0.32 mmol/L (55 ± 12 mg/dL) to 1.29 ± 0.28 mmol/L (50 ± 10 mg/dL) (P<.001); triglyceride levels, from 2.23 ± 1.03 mmol/L (197 ± 91 mg/dL) to 2.06 ± 1.04 mmol/L (182 ± 92 mg/dL) (P<.001).

Conclusions  Hyperlipidemic postmenopausal women receiving combined sequential estrogen and progestogen replacement therapy demonstrate very significant fluctuations in their lipid and lipoprotein levels. These fluctuations depend on the hormonal phase, ie, estrogen alone or combined with progestogen.

From the Department of Internal Medicine C and The Timit Institute of Reproductive Endocrinology, Tel Aviv-Elias Sourasky Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

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