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Low dose oral contraceptive pills for HRT
Title:A randomized trial of oral contraceptive and hormone replacement therapy on bone mineral density and coronary heart disease risk factors in postmenopausal women
Author: N. Taechakraichana, et al.
Address: Bangkok, Thailand
Source: Obstetrics and Gynecology 95: 87-94 (January) 2000
Summary: To assess the effects of oral contraceptive and HRT on bone mineral density and coronary heart disease risk factors in postmenopausal women, researchers randomized 80 women with 1 to 5 years of natural menopause to receive either a cyclic regimen of ethinyl estradiol, 30 micrograms, and desogestrel, 150 micrograms, or conjugated equine estrogens, 0.625mg 21 days per cycle, and medrogestrone, 5mg 10 days per cycle. After 12 months of treatment, the researchers determined that both conventional HRT and oral contraceptives had resulted in significant increases in bone mineral density of the lumbar spine, trochanter, intertrochanteric region, total hip and Ward triangle region. Only oral contraceptives increased femoral neck bone mineral density. Compared with conventional HRT, oral contraceptives also caused greater suppression of biochemical markers of bone turnover and greater reductions in total and LDL cholesterol. Decreases in diastolic blood pressure were greater with oral contraceptives than with conventional HRT, but both treatment groups showed improvements in systolic blood pressure and fasting plasma glucose levels.
Comment: It is becoming increasingly common to use the newer low dose oral contraceptives during the menopausal transition. The "pill" offers increased stability of the menstrual cycle and at least partial relief from increasing hypoestrogenism. The bone preserving effects of the pill is encouraging. I am not sure that the "synthetic" steroids are better for hormone replacement, but may offer an alternative in problem cases.