Metabolic Impact of Estrogen Replacement Therapy

Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2010; 7 (Sonderheft 1): 119-124

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Keywords: ERT,  Menopause,  Metabolismus,  metabolism

Menopause is associated with unfavourable changes in the blood lipid profile as well as with a deterioration of glucose tolerance, which may help in increasing the incidence of cardiovascular diseases. In the same way Hormone Replacement Therapy (HRT) has different metabolic impact in relationship to the dose of estrogen component, the type of progestin and the route of administration. Most of the studies analyzed the effect of the combined estroprogestin therapy, therefore, the impact of the estrogen component alone isn’t always differentiable but principal results are generally consistent. This review aimes to expound the metabolic impact of the estrogen replacement administration in postmenopausal women. A literature review was conducted to identify all the prospective, the randomized trials and to compare the effects of both low and high-dose therapy and route of administration (oral and transdermal). The results of estrogen replacement therapy on glucose metabolism showed minimal changes and differences among treatments. Some studies showed that neither peroral nor transdermal estradiol replacement therapy induced any negative effects on glucose metabolism. The estrogen substitution increases the rate of apolipoprotein metabolism in various degrees, depending on the type of lipoprotein. At present a considerable data document an increase in HDL and a reduction of LDL cholesterol, following estrogen therapy. Studies have clearly established that the estrogen treatment decreases total plasma cholesterol and increases or maintains plasma triglyceride levels. In conclusion the studies of ERT’s effects on glucose and lipid metabolism are heterogeneous but all together the ERT impact may be considered neutral. However the low doses of estrogen therapy may give some beneficial effects. Above all the treatment may prevent the physiological worsening of the glucose and lipid metabolism in menopause.