Can estrogen and progesterone Hormone Replacement Therapy (HRT) increase Low-Density Lipoprotein (LDL) and Non-High-Density Lipoprotein (non-HDL) cholesterol in women?

From the Guidelines

Hormone replacement therapy (HRT) with estrogen and progesterone generally does not increase LDL or non-HDL cholesterol in women; in fact, it often has beneficial effects on cholesterol profiles. Estrogen therapy typically decreases LDL cholesterol and increases HDL cholesterol, creating a more favorable lipid profile, as noted in a study published in Circulation in 2001 1. However, the progesterone component can sometimes partially offset these benefits, depending on the specific type used. Synthetic progestins like medroxyprogesterone acetate may have less favorable effects on lipids compared to natural progesterone. The route of administration also matters - oral estrogen tends to have stronger effects on cholesterol than transdermal forms. Some key points to consider include:

• The effects of HRT on lipid profiles can vary depending on the individual and the specific formulation used, as discussed in a 2013 study published in the Annals of Internal Medicine 1.
• Women with existing cardiovascular disease, diabetes, or other risk factors should discuss their specific situation with their healthcare provider, as individual responses to HRT can vary.
• Age and timing of HRT initiation are also important factors, with better outcomes typically seen when therapy begins closer to menopause.
• Regular lipid monitoring is recommended for women on HRT to ensure any unfavorable changes can be addressed promptly, as suggested by a 2002 study in the Annals of Internal Medicine 1.

From the Research

Effects of Estrogen and Progesterone Hormone Replacement Therapy on LDL and Non-HDL Cholesterol

• The effects of estrogen and progesterone hormone replacement therapy (HRT) on LDL and non-HDL cholesterol in women have been studied in several research papers 2, 3, 4, 5, 6.
• According to a study published in 2001, all estrogen alone regimens raised HDL cholesterol and lowered LDL and total cholesterol 2.
• However, the addition of progestogens to estrogen therapy had varying effects on lipid and lipoprotein levels, depending on the type of progestogen used 2.
• A study published in 2000 found that estrogen-progestin replacement therapy led to significant decreases in LDL cholesterol and significant increases in HDL cholesterol 3.
• Another study published in 2001 found that oral estrogen combined with progesterone decreased LDL cholesterol by 8% and increased HDL cholesterol by 13% 4.
• A study published in 1999 found that estrogen-progesterone replacement therapy resulted in significant decreases in total cholesterol, LDL cholesterol, and VLDL cholesterol, and significant increases in HDL cholesterol 5.
• However, a study published in 2002 found that oral conjugated equine estrogens (CEE) increased triglycerides by 20.7% and HDL cholesterol by 9.0%, while transdermal estradiol had no effect on the lipid profile 6.

Key Findings

• Estrogen alone regimens tend to lower LDL and total cholesterol and raise HDL cholesterol 2.
• The addition of progestogens to estrogen therapy can have varying effects on lipid and lipoprotein levels, depending on the type of progestogen used 2, 3, 4, 5.
• Estrogen-progestin replacement therapy can lead to significant decreases in LDL cholesterol and significant increases in HDL cholesterol 3, 4, 5.
• However, some studies have found that certain types of estrogen-progestin replacement therapy can increase triglycerides 4, 6.