Oral, more than transdermal, oestrogen therapy lowers asymmetric dimethylarginine in healthy postmenopausal women: a randomized, placebo-controlled study


T. Teerlink PhD, Department of Clinical Chemistry, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
(fax: +31 20 444 3895; e-mail: t.teerlink@vumc.nl).


Objective.  To compare the effects of oral and transdermal hormone therapy (HT) on asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, in postmenopausal women.

Design.  In a multicentre, placebo-controlled, double-blind study, 152 hysterectomized healthy women were randomized to receive daily transdermal 17β-oestradiol (tE2, n = 33), or oral micronized 17β-oestradiol either unopposed (oE2, n = 37), or continuous combined with gestodene (oE2 + G, n = 33), or placebo (n = 49) for 13, 28-day treatment cycles. Plasma concentrations of ADMA, arginine and symmetric dimethylarginine (SDMA) were measured at baseline and in treatment cycles 4 and 13 with a high-performance liquid chromatography method.

Results.  After 13 cycles all active treatment groups showed a significant reduction in ADMA compared with placebo: tE2, −4.0% (95% CI: −7.5 to −0.6%); oE2, −7.7% (95% CI: −10.9 to −4.4%) and oE2 + G, −7.5% (95% CI: −10.8 to −4.3%). ancova showed a significantly larger reduction in the oral groups compared with the transdermal group (tE2 vs. oE2 and tE2 vs. oE2 + G, both P < 0.01). Oral, but not transdermal treatment, significantly reduced arginine compared with placebo. All active treatments reduced SDMA; however, this was only statistically significant in the oE2 group.

Conclusion.  Reduction of ADMA was more pronounced after oral than after tE2 administration. Adding gestodene to oral 17β-oestradiol did not alter the reduction of ADMA. The clinical implications of these findings remain uncertain; however, the decrease of ADMA by 17β-oestradiol could be a key phenomenon in the modulation of nitric oxide synthesis by postmenopausal HT.