Short-term effects of low-dose estrogen/drospirenone vs low-dose estrogen/dydrogesterone on glycemic fluctuations in postmenopausal women with metabolic syndrome

Abstract

This study aims to compare the effects of low-dose emidrate estradiol/drospirenone (E2/DRSP) vs low-dose emidrate estradiol/dydrogesterone (E2/DG) combination on the mean amplitude of glycemic excursions (MAGE) value in postmenopausal women affected by metabolic syndrome (MS). One hundred sixty postmenopausal women were recruited to receive a treatment with oral doses of E2/1 mg plus drospirenone/2 mg (E2/DRSP group) or oral dose of E2/1 mg plus dydrogesterone/5 mg (E2/DG group) for 6 months. At enrollment and after 6 months, anthropometric, metabolic, and inflammatory parameters have been assessed. MAGE, evaluated during 48-h continuous subcutaneous glucose monitoring (CSGM), allowed us to assess daily glucose fluctuations at baseline and after 6 months. After hormone therapy, both groups showed a significant decline in fasting plasma glucose levels (p<0.05), while only E2/DRSP group showed a statistically significant decline in waist circumferences, post-prandial glycemia, LDL, plasma triglycerides, MAGE, HOMA index, and plasma IL-6 (p<0.05) levels. In the whole population (n=160), after 6 months of indicated therapy, changes in fasting plasma glucose and PAI-1 levels correlated with the changes in MAGE values, while only in E2/DRSP group that MAGE reduction was positively associated with a stronger decrease in waist circumferences, triglycerides, and TNF-α plasma levels. The independent effect of hormone therapy (HT) on reduction in MAGE value has been tested in three different multiple linear regression models. HT resulted to be associated with MAGE, independent of other confounding variables. Although both groups had a decline in fasting plasma glucose, only drospirenone treatment revealed positive effects on glycemic excursions and insulin sensitivity, induced favorable changes in lipid profile, and showed an improvement of inflammatory indices in postmenopausal women with MS.

Efficacy of Low-Dose Paroxetine for the Treatment of Hot Flushes in Surgical and Physiological Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Trials

“…For this reason, the North American Menopause Society described paroxetine as a first-choice drug for those non-suitable patients and for those who refuse hormonal therapy [25]. Together with VMS, paroxetine has been reported to be useful also in decreasing chronic pelvic pain in pre, peri-, and postmenopausal women, leading to an improvement of social relationships, sexuality, and mental health [26,27,28,29,30,31,32]…”

Effectiveness and safety of 17β-estradiol / drospirenon для менопаузальной гормональной терапии у пациенток с риском развития метаболического синдрома

“…Интересное сравнительное исследование опубликовано группой авторов, показавших снижение уровня тестостерона, триглицеридов и массы тела на фоне приема препаратов для менопаузальной гормональной терапии с дроспиреноном в отличие от дидрогестерона. Кроме того, они выявили снижение уровня гена ингибитора активатора плазминогена 1 (PAI-1) в плазме крови и тенденцию к снижению уровней интерлейкина-6 (IL-6) и фактора некроза опухоли-α (TNF-α) [15]. Известно, что PAI-1 является маркером субклинического воспаления и, наряду с С-реактивным белком и IL-6, ассоциируется с инсулинорезистентностью и гипертензией [16].…”

Treating Arterial Stiffness Associated with Features of Metabolic Syndrome Not Included in its Diagnostic Criteria: Cutting Off the Heads of Lernaean Hydra, Keeper of the Underworld

“…In addition, systolic and diastolic BP and HOMA-IR independently correlated with PWV [87]. It has been suggested that low-dose emidrate estradiol/drospirenone vs low-dose emidrate estradiol/ dydrogesterone combination might be an option to manage MetS features, particularly impaired glucose metabolism [90]. Both combinations induced a decline in FPG levels but only drospirenone exerted positive effects on FPG levels and IR, induced favourable changes in the lipid profile and reduced inflammatory indices in postmenopausal women with MetS [90].…”