[Effects of hormone replacement therapy in menopause on cardiovascular risk. Need for a European study]. / Effets du traitement hormonal substitutif de la ménopause sur le risque cardiovasculaire. Plaidoyer pour un essai européen.

The increased risk of coronary heart disease (CHD) after menopause is currently attributed to estrogen deficiency. Many epidemiological (case-control and prospective) studies have reported a decreased risk (0.5-0.7) of CHD in postmenopausal women receiving hormone replacement therapy (HRT). However, there are some discordant studies, among which the Framingham study. Moreover, the observational studies were subject to several biases that may have falsely elevated the apparent benefit of estrogen: women taking estrogen tend to be wealthier, more educated and healthier than untreated women. Large randomized clinical trials of secondary (HERS, WEST) or primary (WHI) prevention have not confirmed cardioprotection with HRT. However, these studies used orally administered estrogens, while the non-oral route of administration is frequently used in Europe. From a biological point of view, estrogen has multiple effects that would be expected to be cardioprotective, including favorable changes in lipids, endothelial function, vascular reactivity and blood flow. However, concerning hemostasis factors, a pro-coagulant effect can be induced by the first pass liver effect of estrogen when administered orally, which is not observed with the non oral routes of administration. In addition, the synthetic progestin medroxy-progesterone acetate (MPA) inhibits the beneficial effects of estrogen on the arterial wall, whereas natural progesterone does not. It is therefore urgent that Europeans undertake a European "HERS study" in order to investigate the possible beneficial effect of non-oral estrogens (administered percutaneously or transdermally) associated with natural progesterone.

[Variation in plasma progesterone induced by the vaginal administration of Utrogestan]. / Variations de la progestérone plasmatique induites par l'administration vaginale d'Utrogestan.

The authors of this article have been trying to find out how natural progesterone contained in Utrogestan tablets are absorbed by the body when these tablets are placed in the vagina. To do this they conducted their studies on genitally active young women who had volunteered, who were not pregnant and who were not taking hormones. Several therapeutic protocols were tested. Vaginal administration of 100 mg of progesterone (1 Utrogestan tablet) resulted in an increase in blood progesterone levels within an hour. It reached its maximum level after 2 to 6 hours and lasted for 24 hours on an average. The average level was 3.7 ng/ml with a dose of 100 mg/day and 9.7 ng/ml with a dose of 200 mg/day. One capsule every 12 hours ensures that the least variation between individuals occurs. It is the most worth-while dosage and the one recommended by the authors of this article.