| HORMONE REPLACEMENT THERAPY | PEER-REVIEW 10 patients. They
observed an increase of 5.7% of bone density in lumbar spine and 5.2% in femoral neck in these women, through the bone mineral densitometry (DEXA) after 1 year. In women who kept using oral isolated oestradiol there were no changes in bone density21
.
Lipid profile Britto et al studied 122 patients in a 1 year prospective cohort using implants of oestradiol and testosterone and observed improvement in the lipid profile (total cholesterol, HDL and triglycerides) after 1 year22
. Farish et al studied 14 oophorectomized women
treated with 50 mg implants of oestradiol and 17 with implants of oestradiol plus testosterone (50 and 100 mg respectively). During 6 months they showed that the LDL reduced in both groups and LDL did not suffer modifications in the group taking oestradiol plus testosterone23
. One benefit of the use of implants is the continuous
maintenance of serum levels of oestradiol and testosterone. Filho et al, studied 258 women using oestradiol and testosterone implants resulting in blood levels that ranged from 35 to 50 pg/mL of oestradiol and physiological blood levels that ranged from 50 to 80 ng/ dl of testosterone. Zang et al, studied 63 women using oral testosterone undecanoate 40 mg and oestradiol valerate (2 mg daily) and found an average of 40–49 ng/dl of serum testosterone24,13 for females.
, which is within average levels References
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11. Colditz GA, Willett WC, Stampfer MJ, Rosner B, Speizer FE, Hennekens CH. Menopause and the risk of coronary heart disease in women. N Engl J Med 1987; 316(18): 1105–1110
12. Stampfer MJ, Colditz GA, Willett WC, Manson JE, Rosner B, Speizer FE, Hennekens CH. Postmenopausal oestrogen therapy and cardiovascular disease. Ten-year follow-up from the nurses’ health study. N Engl J Med 1991; 325(11): 756–762
13. Leão LM, Duarte MP, Silva DM, Bahia PR, Coeli CM, de Farias ML. Influence of methyltestosterone postmenopausal therapy on plasma lipids, inflammatory factors, glucose metabolism and visceral fat: a randomized study. Eur J Endocrinol 2006; 154: 131–139
14. Zang H, Carlström K, Arner P, Hirschberg AL. Effects of treatment with testosterone alone or in combination with estrogen on insulin sensitivity in
postmenopausal women. Fertil Steril 2006; 86: 136–144
15. Watts NB, Notelovitz M, Timmons MC, Addison WA, Wiita B, Downey LJ. Comparison of oral estrogens and estrogens plus androgen on bone mineral density, menopausal symptoms, and lipid-lipoprotein profiles in surgical menopause. Obstet Gynecol 1995; 85:529–537
16. Castelo-Branco C, Vicente JJ, Figueras F, Sanjuan A, Martínez de Osaba MJ, Casals E, Pons F, et al. Comparative effects of estrogens plus androgens and tibolone on bone, lipid pattern and sexuality in postmenopausal women. Maturitas 2000; 34: 161–168
17. Garnett T, Studd J, Watson N, Savvas M. A cross-sectional study of the effects of long-term percutaneous hormone replacement therapy on bone density. Obstet Gynecol 1991; 78(6): 1002–1007
18. Studd J, Savvas M, Waston N, Garnett T, Fogelman I, Cooper D. The relationship between plasma oestradiol and the increase in bone density in postmenopausal women after treatment with subcutaneous hormone implants. Am J Obstet Gynecol 1990; 163(5 Pt 1): 1474–9
19. Britto R, Araujo L, Barbosa I, Silva L, Rocha S, Valente AP. Hormonal therapy with oestradiol and testosterone implants: bone protection? Gynecol Endocrinol 2011; 27(2): 96–100
20.Davis SR, McCloud P, Strauss BJ, Burger H.
Testosterone enhances oestradiol’s effects on postmenopausal bone density and sexuality. Maturitas 2008; 61(1-2): 17–26
21. Savvas M, Studd JW, Norman S, Leather AT, Garnett TJ, Fogelman I. Increase in bone mass after one year of percutaneous oestradiol and testosterone implants in post-menopausal women who have previously received long-term oral oestrogens. Br J Obstet Gynaecol 1992; 99(9): 757–760
22. Britto R, Araújo L, Barbosa I, Silva L. Improvement of the lipid profile in post menopausal women who use oestradiol and testosterone implants. Gynecol Endocrinol 2012; 28(10): 767–9
23. Farish E, Fletcher CD, Hart DM, Azzawi FA, Abdalla HI, Gray CE. The effects of hormone implants on serum lipoproteins and steroid hormones in bilaterally oophorectomised women. Acta Endocrinol (Copenh) 1984; 106(1): 116–120
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prime-journal.com | January/February 2015 ❚
Conclusion The benefits of the use of oestradiol and androgen subdermic implants have been demonstrated in publications resulting from studies with a reduced number of patients, in non-probabilistic samples, and most of them observational. On the other hand, the results converge towards an improvement of the lipid profile and increase in the bone mineral density in the patients in post menopause. Additional studies are being conducted by the author to further support the use of subdermic implants for hormone replacement therapy.
Declaration of interest None
Key points A physiological
decrease in circulating levels of sex hormone- binding globulin (SHBG) occurs near menopause
The increase in SHBG
levels is less evident when oestrogen therapy is administered in the form of subcutaneous implants
The benefits of
hormonal therapy was demonstrated in recent studies through the increase of bone mineral density among users of a oestradiol plus testosterone combination
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