Summary
After menopause the haemostatic balance shifts towards a latent hypercoagulable state.
To evaluate the effects of two regimens of transdermal estradiol (E2) combined with
progestin on the balance between procoagulant factors and inhibitors, 255 women in
physiological menopause for 1-5 years were randomly allocated to 1 year of treatment
with cyclic transdermal E2 (50 Μg/day for 21 days) plus medroxyprogesterone acetate
(MPA) (10 mg/day from days 10 to 21), continuous transdermal E2 (50 Μg/day for 28
days) plus MPA (10 mg/day from days 14 to 25), or placebo. Fibrinogen, factor VII
(FVII), factor VIII:C (FVIII:C), antithrombin III (ATIII), protein C, protein S, heparin
cofactor II (HCII) and plasminogen activator inhibitor (PAI-1) levels were measured
at baseline and after 6 and 12 cycles. 167 women who took the treatment for at least
6 cycles were evaluable. The continuous treatment group had significantly lower final
values of fibrinogen, FVII, ATIII, protein S and HCII than the placebo group; the
cyclic treatment reduced fibrinogen in comparison with placebo but the difference
was not significant.
In conclusion, both regimens produce a clinically relevant decrease of fibrinogen
levels; the continuous regimen affects also the levels of FVII and inhibitors suggesting
that the haemostatic balance is shifted to a more physiological state.
