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Clinical Endocrinology

Differential impact of conventional oral or transdermal hormone replacement therapy or tibolone on body composition in postmenopausal women

Authors


Willy Hänggi Universitäts-Frauenklinik, Inselspital, Schanzeneckstrasse 1, CH-3012 Bern, Switzerland. Fax: + 41 31 300 1414

Abstract

OBJECTIVE

To compare the effects on body composition and body weight of tibolone vs two different sequential oral or transdermal oestrogen-progestogen hormone replacement therapies versus no therapy.

PATIENTS AND METHODS

One hundred postmenopausal women were assigned to a control group (n = 26), or randomized to 1) tibolone (TIB) 2.5 mg/day (n = 28), 2) oral oestradiol 2 mg/day (PO) plus sequential dydrogesterone 10 mg/day for 14 of 28 days per cycle (n = 26), or 3) transdermal oestradiol patch (TTS) releasing 50 μg/day plus oral sequential dydrogesterone 10 mg/day for 14 of 28 days per cycle (n = 20). Body composition was measured at the baseline and every 6 months for 2 years by DXA (Hologic QDR 1000 W).

RESULTS

Total body fat mass increased (P < 0.05) in controls (+ 3.6 ± 1.5%) and in TTS treated (+ 4.7 ± 2.2%), but not in PO (−1.2 ± 2.4%) and TIB (−1.6 ± 2.2%) treated subjects. This increase in total fat mass in controls and TTS treated women was mostly due to an increase in fat mass of the trunk (P < 0.05), but not legs. As a result, a redistribution of body fat to the trunk occurred in controls, TTS and TIB, but not in PO treated women (P < 0.05). Total lean body mass decreased (P < 0.02) in controls (−1.7 ± 0.7%) and PO (−1.4 ± 0.6%), but not in TTS (+ 0.3 ± 0.8%) and TIB (+ 0.4 ± 0.5%) treated subjects.

CONCLUSIONS

The menopause is associated with an increase in total body fat and a decline in lean body mass. Oral oestradiol/dydrogesterone and tibolone prevent total body fat changes, whereas transdermal oestradiol/oral dydrogesterone and tibolone prevent the lean mass changes. Furthermore, oral oestradiol/dydrogesterone prevents the shift to a cen_tral, android fat distribution.

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