New developments in the management of osteoporosis.

in Climacteric : The Journal of the International Menopause Society (2008), 11(S2), 30

Added benefits of drospirenone for compliance

in Climacteric : The Journal of the International Menopause Society (2005), 8(Suppl. 3), 28-34

Drospirenone is a novel progestogen that possesses antimineralocorticoid activity. This activity is seen clinically in its effects on physiological parameters, body weight, general well-being and fluid ... [more ▼]

Drospirenone is a novel progestogen that possesses antimineralocorticoid activity. This activity is seen clinically in its effects on physiological parameters, body weight, general well-being and fluid-related symptoms. Clinical studies with an oral contraceptive containing 30 fig ethinylestradiol and 3 mg drospirenone (Yasmin (R), Schering AG, Berlin, Germany) and a new continuous combined oral hormone replacement therapy (HRT) containing 1 mg 17 beta-estradiol and 2 mg drospirenone (Angeliq (R), Schering AG) were all designed specifically to evaluate treatment effects on body weight and cardiovascular function, both of which can be influenced by aldosterone receptor antagonism. Weight gain during traditional oral contraceptive and HRT use has been one of the main reasons for poor compliance and discontinuation. Women receiving hormone therapy with I mg 17 beta-estradiol/2 mg drospirenone had either no weight change or a small decrease, while those receiving estradiol alone tended to increase in weight. Mean body weight after 1 year of treatment with 1 mg 17 beta-estradiol/2 mg drospirenone decreased by 1.2 kg (p < 0.001). Studies using different drospirenone doses in combination with estradiol indicate that the effect on body weight is dependent on the dose of drospirenone, and that this is due to drospirenone's antimineralocorticoid activity. These data are in agreement with previous studies that compared the changes in body weight in young women receiving for 13 or 26 cycles the oral contraceptives 30 mu g ethinylestradiol/3 mg drospirenone or 30 mu g ethinylestradiol/150 mu g desogestrel (Marvelon (R), Organon International); 30 mu g ethinylestradiol/3 mg drospirenone had a more favorable effect on body weight, with the mean body weight remaining lower than baseline for the majority of women. A variety of physical and emotional changes have been linked to hormonal fluctuations during the menstrual cycle. Fluid retention-related symptoms, such as breast tenderness, swelling, abdominal bloating and skin changes, may affect wellbeing and quality of life. Improvements in these cycle-dependent disorders, together with some psychological symptoms, such as fatigue and depressive mood, are well documented with the use of 30 mu g ethinylestradiol/3 mg drospirenone. Therefore, the effects of hormone therapy with 1 mg 17 beta-estradiol/2 mg drospirenone on quality of life were assessed in the Women's Health Questionnaire. Significant improvements were observed in quality of life during treatment with 1 mg 17 beta-estradiol/2 mg drospirenone, which also resulted in higher mean scores than estradiol alone. Improvements were mainly seen in somatic symptoms, anxiety/fears and cognitive difficulties. 1 mg 17 beta-estradiol/2 mg drospirenone has unique antimineralocorticold properties, which can be attributed to drospirenone. This combination prevents salt and water retention elicited by estrogens, and thereby prevents increases in blood pressure and maintains a stable body weight. Its additional beneficial impact on premenstrual symptomatology and health-related quality of life may improve well-being and clinical tolerance. [less ▲]

Long-term effects of oral estradiol and dydrogesterone on carbohydrate metabolism in postmenopausal women.

in Climacteric : The Journal of the International Menopause Society (1999), 2(2), 93-100

OBJECTIVE: To determine in postmenopausal women the long-term effects on carbohydrate metabolism of the administration of oral micronized 17 beta-estradiol (2 mg/day continuously) and cyclical ... [more ▼]

OBJECTIVE: To determine in postmenopausal women the long-term effects on carbohydrate metabolism of the administration of oral micronized 17 beta-estradiol (2 mg/day continuously) and cyclical dydrogesterone (10 mg/day for 14 days per 28-day cycle). METHODS: A 2-year open-label prospective, non-comparative study was carried out of 13 healthy postmenopausal women receiving cyclical estradiol and dydrogesterone and serving as their own controls. Concentrations of blood glucose, plasma insulin, C-peptide, glucagon and free fatty acids (FFAs) were determined before treatment (base-line) and at 6, 12 and 24 months of hormone replacement therapy under fasting conditions and during a standard 75-g, 3-h, oral glucose tolerance test (OGTT). RESULTS: Fasting blood glucose levels were unchanged throughout the study, and the mean areas under the curves (AUCs) for glucose response increased slightly but non-significantly versus baseline; fasting plasma insulin levels tended a decrease, and AUCs for insulin responses to the glucose load fell by 23% from baseline (not significant); fasting C-peptide levels and AUCs were unchanged; plasma glucagon fasting levels and responses were in the normal range and stable throughout the study; and plasma FFA fasting levels decreased significantly, as well as FFA AUCs during OGTTs, at the 12th and 24th months of the study. CONCLUSIONS: During a 2-year treatment with oral estradiol and cyclical dydrogesterone, a direct progesterone derivative, tolerance to glucose was unchanged, fasting plasma insulin and insulin response to repeated glucose loads were decreased, and C-peptide levels remained unchanged, indicating a potential improvement in insulin sensitivity and clearance, as in younger women; additionally, a slightly enhanced antilipolytic activity of insulin was observed. [less ▲]

Points to consider for the development of new indications for hormone replacement therapies and estrogen-like molecules

in Climacteric : The Journal of the International Menopause Society (1998), 1