Oral Estradiol Therapy

Oral Estradiol therapy may worsen insulin resistance in obese menopausal women with metabolic syndrome, whereas transdermal estradiol has no significant effect on insulin resistance, according to a prospective randomized clinical trial.

Lead investigator Micheline C. Chu, MD, Attending Physician, Division of Reproductive Endocrinology and Infertility, North Shore University Hospital, Manhassett, New York, United States, presented the study findings here on October 19th at the annual meeting of the American Society of Reproductive Medicine (ASRM). "Estrogen therapy after menopause has been suggested to improve insulin sensitivity," said Dr. Chu in an email interview, "although the data have been controversial and may be different depending on the type of patients treated and the dose and type of estrogen administered."

The study investigators randomized 50 obese postmenopausal women with metabolic syndrome to receive 1 mg oral micronized estradiol or 50 mcg transdermal estradiol for 12 weeks. Fasting glucose, insulin, and lipid levels were measured at baseline and week 12. Intravenous insulin tolerance tests (ITT) and 75 g 2-hour oral glucose tolerance tests (OGTT) were performed. After 12 weeks, there was significant worsening of insulin resistance in women taking oral estradiol, baseline insulin increased by 6.74 to 22.02 mcU/mL (P < .01), glucose to insulin ratio decreased by 2.16 to 5.52 (P < .01), and quantitative insulin sensitivity check index (QUICKI) decreased by 0.02 to 0.2977 (P < .01).

The researchers observed no significant changes in markers of insulin resistance in women receiving transdermal estradiol, except for a decrease in glucose to insulin ratio from 7.13 to 5.77(-1.36; P < .05). High density lipoprotein (HDL) cholesterol levels increased in women on oral therapy from 50.46 to 55.08 mg/dL (P < .01). This change was not observed in women on transdermal therapy.

"In the woman with metabolic syndrome who has symptoms of menopause warranting therapy, transdermal estrogen therapy would be preferable," Dr. Chu said. She cautioned, however, that the results of this study were in obese postmenopausal women with metabolic disorder and may not be the applicable to women of normal weight or to more metabolically normal women.

Source: RefillPill.com Editors' Choice