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Abstract
In 55 patients after oophorectomy and 20 women ater natural menopause an oral estrogen
replacement therapy was performed with estrone-sulfate, estradiol 17-valerate, estriol-succinate,
a combination of micronized estradiol and estriol (Estrifam®, Trisequens®), and natural
conjugated estrogens. In 4 patients a 3 mg estradiol per 5 g ointment substance was
applied on the abdominal skin.
The interindividual variations of estrogen increments during therapy were considerably
high. Oral intake of 2 mg estriol-succinate daily was followed by a 500% increase
of total (conjugated + unconjugated) estriol. Concentrations of unconjugated estrogens
were not altered by this dosage. Following oral application of the other above mentioned
preparations, prominent rises - especially of unconjugated estrogens in plasma - were
noted. The concentration peaks ocurred within 3–6 h after application. Unconjugated
estradiol-17β in plasma was comparable with values of the follicular phase of a normal
menstrual cycle, unconjugated estrone, however, was nonphysiologically high. Consequently,
the E1/E2 ratio was greater than one whereas it is normally below one. 12 h after oral estrogen
application, plasma estrogens dropped to almost initial values, so that a second medication
seems to be necessary in order to guarantee an adequate supplementation over the course
of the day.
The hormone values determined in this study did not show significant differences between
patients after a natural menopause and after oophorectomy. There was a positive correlation
between rising estrogen levels and suppressed gonadotrophins during replacement therapy.
The occurrence of climacteric symptoms did not exclusively depend on low estrogen
and high gonadotrophin levels.
Good tolerance of estrogen therapy with significantly elevated estrogen concentrations
in plasma can be obtained transcutaneously in the form of estrogen ointments. Such
therapy might simulate the physiological estrogen pattern even better than oral application
does because of delayed and diluted steroid flow to the liver.
Keywords
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References
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Article info
Publication history
Accepted:
October 16,
1978
Received:
July 14,
1978
Identification
Copyright
© 1979 Published by Elsevier Inc.
