Postmenopozal hormon replasman tedavisi ve serum homosistein düzeyleri

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Thesis Type: Expertise In Medicine

Institution Of The Thesis: Gazi University, Tıp Fakültesi, Cerrahi Tıp Bilimleri, Turkey

Approval Date: 2002

Thesis Language: Turkish

Student: EBRU HACER BİBEROĞLU

Supervisor: AHMET ERDEM

Abstract:

83 SUMMARY A total 208 women, between ages 45-55, were enrolled in the study during a period of 20 months until June 2002, at the outpatient clinic of the Department of Obstetrics and Gynecology at Gazi University Medical School, Ankara, Turkey. The participants were allocated to one of four groups;eumenorrheic or oligomenorrheic pre-menopausal women; post-menopausal women with intact uteri-amenorrheic for at least one year with no treatment; surgically menopausal and hysterectomized women who are on estrogen-only treatment for at least 6 months; and postmenopausal women with intact ovaries and uteri, who have been taking combined estrogen and progestin treatment for at least 6 months. Clinical and epidemiological parameters such as age, menopausal status, height, weight, body mass index, duration of menopause, duration of hormone treatment, smoking and Turkish and instant coffee drinking habits and laboratory parameters such as serum FSH, E2, Hey, AST, ALT, uric acid, creatinin, total cholesterol, HDL, LDL, triglyceride, Apo A, Apo B, vitamin B12, folic acid, PAI-1, Factor VII, CRP, LDH and cupper concentrations were evaluated to compare the effects of endogenous estrogen status and exogenous estrogen and progestin administration on fasting serum total homocysteine concentrations and also to find if there is any correlation between homocysteine and other clinical and laboratory parameters. Mean homocysteine concentration was higher in the postmenopausal untreated women group (the longer the duration of menopause, the higher the mean Hey concentrations were), when compared with menstruating premenopausal women group. In other words, there was a negative correlation between estrogen status and homocysteine which is believed to be an independent risk factor for cardiovascular disease.In contrast to this finding, administering84 either estrogen or estrogen/progestin combination exogenously, surprisingly increased homocysteine concentrations even further, suggesting that, homocysteine metabolism does not play an intermediate role in the reported cardiovascular protection associated with HRT use or HRT in fact increases the cardiovascular risk. Significant correlation was detected between serum Hey and serum AST, Apo A, Apo B, HDL and cupper concentrations. The subgroup statistical analysis and analysis of covariance after the effects of these parameters on Hey were corrected, Apo A was the only dependent parameter among all, and the rest were independent variables.Receiver operating curve analysis revealed the cut off serum Hey concentration to be 9.45unol/L in differentiating the premenopausal from the postmenopausal women. In conclusion, hormone replacement treatment increases the mean homocysteine and cupper concentrations, which may have unfavorable effects on cardiovascular system and general health status, in postmenopausal women.