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Cardiovascular Effects of Physiological and Standard Sex Steroid Replacement Regimens in Premature Ovarian Failure
Abstract
Current hormone replacement therapy may not optimize cardiovascular health in women with premature ovarian failure. We compared the effects of physiological and standard sex steroid replacement regimens on cardiovascular health in these women. In an open-label, randomized, controlled crossover trial, 34 women with premature ovarian failure were randomly assigned to 4-week cycles of physiological (transdermal estradiol and vaginal progesterone) and standard (oral ethinylestradiol and norethisterone) therapy for 12 months. Cardiovascular health was assessed by 24-hour ambulatory blood pressure, arterial stiffness, and renal and humoral factors. Eighteen women (19 to 39 years of age) completed the 28-month protocol. Both regimens caused similar suppression of luteinizing hormone and follicle-stimulating hormone and provided symptom relief. In comparison with the standard regimen, physiological sex steroid replacement caused lower mean 24-hour systolic and diastolic blood pressures throughout the 12-month treatment period (ANOVA; P ≤0.0001 for both): systolic blood pressure was 7.3 mm Hg (95% CI: 2.5 to 12.0 mm Hg) and diastolic was 7.4 mm Hg (95% CI: 3.9 to 11.0 mm Hg) lower at 12 months. Although there were no differences in arterial stiffness, physiological sex steroid replacement reduced plasma angiotensin II (ANOVA; P =0.007) and serum creatinine (ANOVA; P =0.015) concentrations without altering plasma aldosterone concentrations. In comparison with a standard regimen, physiological sex steroid replacement in women with premature ovarian failure results in lower blood pressure, better renal function, and less activation of the renin-angiotensin system. These findings have major implications for the future cardiovascular health of young women who require long-term sex steroid replacement therapy.
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“There is some evidence that blood pressure may be substantially lower with TD E2 preparations compared to oral ethinyl E2, but this has not been tested specifically in TS.359”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [359]
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Metadata
- Authors
- Langrish, J. P., Mills, N. L., Bath, L. E., Warner, P., Webb, D. J., Kelnar, C. J., Critchley, H. O. D., Newby, D. E., & Wallace, W. H. B.
- Affiliations
- University of Edinburgh (GB)
- ORCID
- Venue
- Hypertension
- Published
- 2009-05
- Volume
- 53
- Issue
- 5
- Pages
- 805-811
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2161581155
- Cited by
- 207
- References
- 37
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 16 · 2023: 15 · 2022: 20 · 2021: 16 · 2020: 16 · 2019: 20 · 2018: 16 · 2017: 15 · 2016: 10 · 2015: 6 · 2014: 4 · 2013: 5 · 2012: 9
- FWCI
- 7.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- British Heart Foundation (FS/07/048)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Estrogen and related hormone effects
- Keywords
- premature ovarian failure, sex hormone replacement therapy, transdermal estradiol, vaginal progesterone, ethinyl estradiol, norethisterone, cardiovascular health, blood pressure, arterial stiffness, renin-angiotensin system, angiotensin II, aldosterone, renal function, luteinizing hormone suppression, follicle-stimulating hormone
- MeSH terms
- Adult, Arteries, Blood Pressure, Female, Humans, Estrogen Replacement Therapy, Primary Ovarian Insufficiency, Cross-Over Studies, Blood Pressure Monitoring, Ambulatory
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