A review has recently been published in the prestigious Journal of the Endocrine Society which addresses the safety and physiological effect of progesterone as a balancing agent, compensating for the effect of HRT with estrogens, and the beneficial effects of this association at a cardiovascular level of said association.

The results are clear: the bioidentical progesterone compensates for the estrogen effluvium of the hormone replacement therapy without presenting risks of any kind at a cardiovascular or oncological level. Replacement with estrogen, in any of its forms (oral, topical, pellet, etc.) relieves the harmful effects at a cardiovascular level. I.e. it reduces the levels of total cholesterol and of its LDL sub-fraction, in addition to having a positive effect on other sub-fractions such as ApoB and Lipoprotein.

Dr. Francisco Martínez Peñalver – Neolife Medical Team

In the menopause there are a series of changes that are negative for women’s health

The menopause signals the end of the fertile period in women, at an age that usually is around 50. There are numerous changes at a hormonal level that explain the appearance of classic symptoms such as hot flashes, night sweats, emotional lability, vaginal dryness, decrease in libido, etc. (1). In addition to these symptoms, the cessation of the production of estrogen and progesterone by women leads to the appearance of an increased risk of cardiovascular disease and osteoporosis.

In terms of cardiovascular diseases, estrogens have a favorable effect on the wall of the blood vessels, hindering the formation of atheromatous plaque. Furthermore, when production ceases, there is an increase in the entire lipid profile, with which two of the most suitable conditions for the formation of the aforementioned plaque (2) are combined at the vascular level.

Estrogen replacement, in any of its forms (oral, topical, pellet, etc.) relieves these harmful effects at a cardiovascular level. I.e. it reduces the levels of total cholesterol and of its LDL sub-fraction, in addition to having a positive effect on other sub-fractions such as ApoB and Lipoprotein (a). However, there has always been a certain amount of controversy when determining which molecule should accompany the estrogen in order to balance its possible side effects. Classically progestins have been used. These are molecules that partly attenuate the side effects but at the same time increase the rate of cardiovascular events (since they worsen the lipid profile) and that of cancer.

A review has recently been published in the prestigious Journal of the Endocrine Society which addresses the safety and physiological effect of progesterone as a balancing agent, compensating for the effect of hormone replacement therapy with estrogen, and the beneficial effects at the cardiovascular level of this association (3). The results are clear: bioidentical progesterone compensates for the estrogen effluvium of the hormone replacement therapy without presenting risks of any kind at a cardiovascular or oncological level. The addition of 300 mg of micronized progesterone did not alter the decrease in lipid profile produced by the addition of estrogen, and did not influence the beneficial effect of estrogen on endothelium-dependent vasodilation, which is the main mechanism by which estrogen hinders lipid depositing and the formation of plaque on the walls of the artery.

Another important aspect to keep in mind is that progesterone only has receptors in the female reproductive organs, the pituitary gland and the brain, while progestins act as a kind of weak androgen, i.e. in a pernicious way, on the adrenal glands, and via these, indirectly, on the entire organism.

In the field of obesity, progesterone does not produce the increase in resistin and leptin, nor the decrease in adiponectin produced by progestins, and which lead to greater inflammation of fat tissue, increasing aspects that are fundamental for the development of obesity, such as insulin resistance (4).

Our aim with this Newsletter is thus to convey a core idea of ​​what the new, but at the same time more effective and safe, approach to the hormone replacement therapy we carry out at Neolife means. During the menopause there are a series of changes that are negative for women’s health, mainly hormonal ones, which result in a clear loss in the quality of life and at the same time an increase in the rate of occurrence of cardiovascular and oncological diseases.

The fact of using bioidentical hormones provides these patients with the peace of mind of knowing they can avoid the possible complications at the cardiovascular level found with other compounds, as demonstrated by the evidence we provide in this Newsletter, especially regarding progestins, which can behave like agents that are truly toxic for our arteries.

In fact, a change in the way the different Public Institutions and organisms like the NAMS (North American Menopause Society) are thinking is already being seen. Every year they are clearer when it comes to their recommendations.

BIBLIOGRAPHY

(1) Gastlehner et al. Hormone Therapy for the primary prevention of chronic conditions in postmenopausal women: evidence report and systematic review for the US Preventives Task Force. JAMA. 2017;318(22):2234-49.

(2) Muesing RA et al. Cyclic changes in lipoprotein and apolipoprotein levels during the menstrual cycle in healthy premenopausal women on a controlled diet. J Clin Endocrinol Metab. 1996;81(10):3599-3603.

(3) Roelfsema F et al. Differential effects of estradiol and progesterone on cardiovascular risk factors in postmenopausal women. 2018 July;2(7):794-805.

(4) Lacut K et al. Differential effects of oral and transdermal postmenopausal estrogen replacement therapies on C-reactive protein. Thromb Haemost. 2003;90(1):124-131.