Effect of early estrogen replacement therapy on microvascular reactivity in patients after bilateral ovarectomy.

OBJECTIVES: The aim of the study was to evaluate skin microvascular reactivity (MVR) measured by laser Doppler flowmetry in women early after bilateral ovarectomy treated with oral and transdermal estrogen replacement therapy (ERT).

DESIGN: Interventional, randomized study with a cross-over design.

PATIENTS AND METHODS: 41 patients (49+/-6 years, 6-12 weeks after surgical castration) were treated with 17-beta-estradiol transdermally (0.05 mg/day) or orally (2 mg/day) for three months and 20 healthy female subjects (47+/-5 years) served as controls.

RESULTS: Records of laser Doppler flowmetry were blinded prior to the evaluation. Maximal perfusion and velocity of perfusion increase during post-occlusive reactive hyperemia (PORH) were lower before ERT comparing to controls at baseline (36+/-16 vs. 48+/-18 PU, p<0.05, and 2.8+/-1.9 vs. 4.2+/-2.3 PU, p<0.05, respectively). Velocity of perfusion increase in PORH decreased after oral ERT compared to baseline and also to transdermal ERT (2.1+/-1.2 vs. 2.8+/-1.9 PU.s-1, p<0.05, and vs. 3.5+/-3.2 PU.s-1, p<0.01, respectively), nonsignificant increase of this parameter after transdermal ERT led to normalization when comparing to control group (3.6+/-3.2 vs. 4.2+/-2.3 PU.s-1, NS). Increase of HDL-cholesterol and decrease of LDL-cholesterol (2.1+/-0.4 vs. 1.8+/-0.4 mmol.l-1, p<0.01, and 2.5+/-0.7 vs. 3.1+/-1.0 mmol.l-1, p<0.01) was observed after oral ERT while HDL-cholesterol increase after transdermal ERT was less pronounced (1.96+/-0.42 mmol.l-1, p<0.05). LDL-cholesterol levels did not change. A correlation between HDL-cholesterol and maximal post-occlusive flow expressed in % of basal perfusion was observed in patients before treatment (r=0.47, p=0.002).

CONCLUSIONS: Microvascular reactivity is impaired in women early after bilateral ovarectomy. No statistically significant improvement of MVR was observed after oral estrogen replacement therapy, normalization of MVR after transdermal ERT was only partial. Changes of MVR and lipid profile differed between oral and transdermal routes of estrogen replacement therapy.