Endocrine Abstracts

Transition to menopause is associated with increased cardiovascular disease (CVD) risk, mainly attributed to acquisition of a more atherogenic lipid profile, including an increase in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and apolipoprotein B concentrations, and a decrease in high-density lipoprotein cholesterol (HDL-C) concentrations, mostly due to the HDL₂-C subfraction. Derangement in glucose metabolism, visceral adiposity and development of metabolic syndrome also contribute to the menopause-related CVD risk. Inconsistent data exist with regard to blood pressure and lipoprotein (a) [Lp(a)]. Whether the aforementioned changes are translated into an increased risk of CVD events and mortality, irrespective of age, remains to be established. However, this association is evident in cases with early age at menopause (i.e. < 45 years) or premature ovarian insufficiency (POI), which demonstrate a 1.5-2-fold increased CVD risk, compared with women of normal age at menopause. Oestrogen administration ameliorates most of the CVD risk factors to a various extent depending on the regimen, dose, duration and route of administration. In particular, it decreases TC, LDL-C and Lp(a), whereas it increases HDL-C concentrations. The effect on TG depends on the route of administration (i.e. increase with oral and decrease or neutral effect with transdermal oestrogen). Oestrogen also improves insulin resistance and reduces the risk of type 2 diabetes. These effects are dissipated after withdrawal. Menopausal hormone therapy (MHT) is recommended in cases with early menopause or POI, irrespective of the presence of menopausal symptoms. It may be also considered in symptomatic postmenopausal women <60 years old or <10 years since menopause, starting at the lowest effective dose. CVD and breast cancer risk should be assessed prior to MHT. Transdermal oestrogen and micronized progesterone or dydrogesterone are the preferred regimen. In any case, tailoring the MHT regimen according to women’s risk profile and preference, constitute the wisest strategy.