Postmenopausal hormone replacement therapy and cardiovascular disease: the value of transdermal estradiol and micronized progesterone

ABSTRACT

Most available postmenopausal hormone replacement therapies (HRT) offer similar efficacy, but differ with respect to the cardiovascular risks associated with their use. There is a wealth of evidence to suggest that, unlike oral estrogens, transdermal estradiol does not increase the risk of venous thromboembolism, probably due to its lack of effect on the coagulation cascade, including thrombin generation and resistance to activated protein C, and does not increase the risk of stroke. It is cardioprotective, significantly reducing the incidence of myocardial infarction compared with non-users; it significantly reduces the incidence of new-onset diabetes, a risk factor for myocardial infarction. Micronized progesterone has also been shown not to increase the risk of venous thromboembolism and further reduced the incidence of new-onset diabetes when combined with transdermal estrogen. Micronized progesterone has a neutral effect on the vasculature, including a neutral or beneficial effect on blood pressure. Therefore, experimental and clinical data indicate that transdermal estradiol and micronized progesterone could represent the optimal HRT, particularly in women at risk of adverse events.

Key words::

• CARDIOVASCULAR DISEASE
• HORMONE REPLACEMENT THERAPY
• PROGESTERONE
• MYOCARDIAL INFARCTION
• STROKE
• TRANSDERMAL ESTRADIOL
• VENOUS THROMBOEMBOLISM

ACKNOWLEDGEMENT

Assistance with writing this manuscript was provided by Clare Ryles, medical writer, and funded by Besins Healthcare.

Conflict of interest A. O. Mueck has been involved in trials and/or experimental research regarding hormone replacement therapy sponsored by Bayer Schering, Jenapharm, Dr. Kade/Besins, Wyeth, MSD and Novartis. He has received from those companies consultancy fees, lecture fees and financial support to conduct research on sexual steroids. He serves on the board of several societies and journals covering this issue. He is President of the German Menopause Society.

Source of funding The content of this article was based on a presentation given at a symposium, sponsored by Besins Healthcare, at the 2011 World Congress on Menopause of the International Menopause Society.