Prospective, randomized, controlled study of the effect of hormone replacement therapy on peripheral blood flow velocity in postmenopausal women

Abstract

Objective: To investigate the effect of different types and methods of delivery of hormone replacement therapy (HRT) on peripheral vascular flow velocity in postmenopausal women. Design: A prospective, randomized, operator-blinded, controlled study. Setting: A hormone replacement clinic in a university teaching hospital. Patient(s): Sixty-eight women who had undergone surgical menopause. Intervention(s): No treatment, oral estrogen, continuous combined estrogen and progestogen, or percutaneous estrogen. Main Outcome Measure(s): The pulsatility indices of the brachial, dorsalis pedis, popliteal, and radial arteries were measured under standardized conditions before the commencement of HRT and after 2 and 6 months of treatment. Serum E 2 levels were measured at each visit. Result(s): There was an inverse correlation between the serum E 2 levels and the pulsatility indices. There was a significant reduction in the pulsatility index in at least one of the four arteries after 2 months of HRT in all the treatment groups but not in the control group. The effect of HRT on the pulsatility index persisted until the completion of the study in all the treatment groups. Conclusion(s): These results confirm that the administration of HRT is associated with a reduction of the pulsatility index, and hence an increase in blood flow in the peripheral arteries; this change in the pulsatility index is related directly to serum E 2 levels. The percutaneous route of administration of estrogen was at least as effective as oral treatment in improving peripheral vascular flow velocity. The beneficial effect of estrogen was not affected by the addition of a progestogen.