Hormone replacement therapy in perimenopausal women and 2-year change of carotid intima-media thickness

Objectives: To assess the 2-year effects of a combined regimen of oral 17 beta-estradiol and desogestrel (17 beta E-D) and a sequential combination of conjugated equine estrogens and norgestrel (CEE-N) on common carotid intima-media thickness and end-diastolic lumen diameter in comparison to placebo in perimenopausal women. Methods: The study was a single center, randomized, group-comparative, double-blind study with respect to the 17 beta E-D and placebo groups and open with respect to CEE-N. After cycle 6, the blind was broken and the trial was continued as an open trial for another 18 months for the active study arms. The study included 121 perimenopausal women recruited from the general population. Common carotid intima-media thickness and end-diastolic lumen diameter were measured at baseline and cycle 24 with B-mode ultrasonography. Results: At cycle 24 small changes in intima-media thickness and lumen diameter were observed. Relative to placebo, changes in intima-media thickness were - 0.009 mm [95% CI - 0.045; 0.027] for 17 beta E-D and - 0.016 mm [95% CI - 0.055; 0.024] for CEE-N. For end-diastolic lumen diameter the changes were - 0.091 mm [95% CI - 0.236; 0.055] and - 0.125 mm [95% CI - 0.820; 0.032] for 17 beta E-D and CEE-N, respectively. Conclusions: In this study among perimenopausal women a significant effect of 17 beta E-D and CEE-N on common carotid intima-media thickness and lumen diameter could not be demonstrated. Although the sample size of the present trial is too limited to provide definite conclusions, the direction of the effect is in agreement with evidence from earlier studies on the effects of hormone replacement therapy in postmenopausal women. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.