Conjugated estrogen/progestagen versus tibolone hormone replacement therapy in postmenopausal women : effects on carbohydrate metabolism and serum sex hormone-binding globulin

• Objective: To study the effects of different types of continuous hormone replacement therapy on carbohydrate metabolism. Method: Postmenopausal women were treated with conjugated estrogens, 0.625 mg/medroxyprogesterone acetate, 2.5 or 5mg (CEE/MPA) or tibolone 2.5 mg daily for 13 28-day cycles. Serum glucose and insulin were measured before and during a 75 g oral glucose tolerance test (OGTT) at baseline and after 3, 6 and 13 cycles and areas under the curve (AUC) were calculated. Sex hormone-binding globulin (SHBG) was measured as an additional marker of nutritional and insulin status. Results: Neither CEE/MPA2.5 mg nor tibolone had any effects on carbohydrate metabolism whileAUCinsulin, AUCglucose and also body mass index (BMI) increased after 13 cycles of treatment in the CEE/MPA 5 mg group. SHBG increased significantly during CEE/MPA treatment and decreased significantly during treatment with tibolone. The effects on SHBG were less pronounced in the CEE/MPA 5 mg group. Pretreatment SHBG showed significant negative correlations to BMI and to variables that may reflect a certain degree of insulin resistance, the most pronounced being fasting glucose. Changes in SHBG during treatment with tibolone were negatively correlated to pretreatment SHBG and positively to BMI, AUCinsulin and fasting insulin resistance index, while no such correlations were found in the CEE/MPA groups. There were no correlations between changes in AUCinsulin and AUCglucose on one hand and basal variables or treatment SHBG on the other in the CEE/MPA groups. Conclusion: The effects of tibolone and CEE/MPA on carbohydrate metabolism were considered to have clinical significance only for CEE/MPA 5 mg, indicating a less favourable role of the higher progestagen dose. The results further support the important role of metabolic and insulin status in the physiological regulation of SHBG and also indicate that the suppressive effect of tibolone on circulating SHBG is mainly depends on pretreatment SHBG levels. SHBG does not reflect changes in carbohydrate metabolism during CEE/MPA treatment.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

Nyckelord

aged

carbohydrate metabolism/*drug effects

enzyme-linked immunosorbent assay

Estrogen Receptor Modulators/administration & dosage/*pharmacology

Estrogen Replacement Therapy/methods

Estrogens; Conjugated (USP)/administration & dosage/*pharmacology

Female

Humans

Medroxyprogesterone 17-Acetate/administration & dosage/*pharmacology

Middle Aged

Norpregnenes/administration & dosage/*pharmacology

Postmenopause

Prospective Studies

Regression Analysis

Sex Hormone-Binding Globulin/*drug effects

Sweden

Obstetrics and gynaecology

Obstetrik och gynekologi

obstetrik och gynekologi

Obstetrics and Gynaecology

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)