Serum Lipid Profile in Menopause and Corrective effect of Hormone Replacement Therapy A Study based on Bilaspur District Chhattisgarh

Author: Seema Mishra

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Abstract

Menopause, defined as the last menstrual period in a woman's life, undergoes many significant changes called "climacteric changes". These changes are mainly caused by a lack of estrogen due to ovarian failure. The climacteric changes includes vasomotor hot flashes, sweating, vaginitis and vaginal atrophy, dyspareunia and loss of libido, mental dysfunction-loss of concentration, sleep disturbances, headache, mood swings, depression and loss of energy, altered skin and hair, skin and hair loss. An abnormal, cardio-protective lipid profile due to decreased levels of sex hormones—estrogen and progesterone—contributes to a dramatic increase in the incidence of ischemic heart disease and coronary heart disease in postmenopausal women. Coronary heart disease (CHD) is ten times more common in men than in women up to age 45. Estrogen and, to a lesser extent, progesterone also significantly reduce plasma cholesterol levels, possibly due to the action of these female hormones on lipoproteins. Plasma cholesterol levels are lower in women aged 20-45 than in men of the same age. If both ovaries are removed before the age of menopause, this is often followed by elevated plasma cholesterol and a greatly increased incidence of heart disease. The resulting dyslipidemia is one of the main causes of heart disease, especially ischemic heart disease in post-menopuased women. This was a Community based Case-control study on post-menopuased women including analysis of lipid profile and effect of HRT on serum lipid profile. Menopause was observed as a significant etio-pathological cause of dyslipidemia in studied post-menopaused subjects and positive corrective effect of HRT was seen on their lipid profile.

Keywords

Menopause, Dyslipidemia, Hormone Replacement Therapy, Cardiovascular Disease, Cholesterol, Lipid Profile

Conclusion

When the lipid profiles of premenopausal and postmenopausal women were compared, in all four parameters, serum total cholesterol showed significant differences between the two groups. The same pattern was seen with triglyceride levels, but both groups showed a marked difference in their high-density lipoprotein fraction and low-density lipoprotein fraction. HDL was found to be 0.29 mg/ml in the post-menopausal group, which was significantly lower than the HDL level found in the pre-menopausal group, which was 0.59 mg/ml. The LDL fraction showed the opposite trend, being lower in the pre-menopausal group (0.54mg/ml) and relatively higher in the postmenopausal group (1.26 mg/ml). A significant difference was found between the two groups, which was significant at both the 1% and 5% levels. Compared to the premenopausal group, the postmenopausal group showed a 48% increase in the cholesterol fraction, a 52% increase in the triglyceride fraction, a 51% increase in the HDL fraction, and a 131% increase in the LDL fraction. High levels of HDL is cardio-protective in pre-menopuased women, its a good cholesterol that cleans blood vessels, while LDL on the other hand causes narrowing of blood vessels and leads to cardiac ischemia and eventual arrest. This healthy trend is seen in pre-menopausal women with higher HDL and lower LDL and abnormal lipid profile with lower HDL and higher LDL in postmenopausal women is observed. In one study it was concluded that, this pattern of lipid profile composition can be dangerous because it has an inherent potential to cause heart attacks (Almenar et al., 1997). Total cholesterol increases in postmenopausal women, probably due to the lack of estrogen and progesterone in those women. (Torosyan et al., 2022) similarly, changes in HDL showed a cardio-negative trend after menopause. A significant decrease in this good cholesterol has been reported after menopause. Triglyceride fraction was not significantly different between the two groups. The same observations were noted by the study done by Jeong & Kim (2022). All these changes in the profile after menopause makes women more prone to cardiovascular diseases, especially ischemic diseases. Our study showed that the presence of enough female hormones—estrogen and progesterone in the body of pre-menopausal women may have a protective effect against heart problems by influencing the lipid profile. This may be the reason that in the experimental group of 66 postmenopausal women, 21 (32%) reported some degree of cardiac problems, mainly cardiac ischemia, while in the same number of pre-menopausal group (66), only 3 women showed this trend. Out of 66 (4.54%) were reported to have mild cardiac disorder. By HRT, our studies further support the findings that the estrogen plays a very important role in preventing cardiac problems, possibly due to preventive role of feminine hormones against dyslipidemias (Sreeniwas & Sinha 2020). Participants who were taking oral hormones showed no significant difference after therapy. Only significant changes were observed in LDL fraction. Oral preparations are not preferred mostly, because they first pass the liver and intestines based metabolism and destroyed to some extent (Liver Tox: Clinical and Research Information on Drug-Induced Liver Injury. (2012). Some previous studies have shown that the oral form increases renin substrate production (particularly dangerous for hypertensive participants) and increases thromboembolic disease in people with a positive history (Whitehead, 2006). Interestingly, the present study found the transdermal preparation more effective in improving serum lipid conditions. It significantly alters all serum lipid parameters except triglyceride in a cardio-friendly manner. Transdermal and sub-cutaneous implants may more closely reflect endogenous hormone activity. This finding matches with the work of Gregersen et al. (2019). Subcutaneous estrogen produces a plasma estrogen profile that mimics the ovulatory cycle. Thus the choice of estrogen depends on indication, risk, convenience and patient compliance. Our data provide evidence consistent with previous findings that HRT improves quality and duration of life in postmenopausal women. A lower incidence of stroke and myocardial infarction is also a great benefit. Altering the lipid profile in such a cardio-friendly manner showed that the overall effect of HRT was beneficial to the heart (Alwers et al., 1999).

References

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How to cite this article

Seema Mishra (2023). Serum Lipid Profile in Menopause and Corrective effect of Hormone Replacement Therapy A Study based on Bilaspur District Chhattisgarh. Biological Forum – An International Journal, 15(5a): 368-376.