Document Detail

Randomized comparison of oral and transdermal hormone replacement on carotid and uterine artery resistance to blood flow.
MedLine Citation:
PMID:  9764629     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare the long-term effects of oral and transdermal hormone replacement therapy (HRT) on carotid and uterine vascular impedance. METHODS: Sixty-three postmenopausal women were randomized to 1 year's treatment with oral or transdermal sequential combined HRT. Carotid and uterine artery pulsatility indices (PIs) were assessed by color Doppler at baseline, and after 2, 6, and 12 months of treatment. Fifty-eight women completed the trial, 27 in the oral and 31 in the transdermal group. In a subgroup of 30 women, we also performed Doppler measurements in the estrogen-progestin combined phase. The study had 90% power to detect a difference between treatment groups of 0.05 in the carotid artery and of 0.25 in uterine artery PI at the 5% significance level. RESULTS: The carotid PI decreased significantly (P < .001) and similarly during both regimens. This drop was already clearly detectable during the second month, from 0.97 (0.95, 1.01) (mean and 95% confidence intervals [CII) to 0.94 (0.91, 0.97) in the oral and from 0.98 (0.94, 1.00) to 0.92 (0.89, 0.95) in the transdermal group, but it continued up to 12 months (0.85 [0.82, 0.88], 13% of baseline values in the oral group and 0.84 [0.81, 0.871, 14% in the transdermal group). In the uterine arteries, the drop in PI was steeper and greater and reached its maximum at 6 months (39% and 40%, respectively). Drops in carotid and uterine PI correlated positively with baseline PI values, but were not affected by patient age, time from menopause, previous HRT and smoking. Addition of norethisterone acetate did not counteract drops in carotid and uterine PI in either group. CONCLUSION: Oral and transdermal sequential HRT are similarly effective at 1 year in reducing impedance to flow in carotid and uterine circulation. This long-term vascular effect might explain how HRT protects women from cardiovascular disease.
B Cacciatore; I Paakkari; J Toivonen; M J Tikkanen; O Ylikorkala
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  92     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1998-11-02     Completed Date:  1998-11-02     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  563-8     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, University of Helsinki, Finland.
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MeSH Terms
Administration, Cutaneous
Administration, Oral
Carotid Arteries / drug effects*,  physiology*
Estradiol / administration & dosage*
Hormone Replacement Therapy*
Middle Aged
Norethindrone / administration & dosage,  analogs & derivatives*
Uterus / blood supply*,  drug effects*
Vascular Resistance / drug effects*
Reg. No./Substance:
38673-38-0/norethindrone acetate; 50-28-2/Estradiol; 68-22-4/Norethindrone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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