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[Progestogens, progesterone, coagulation and vascular tone].

J F Schved1, C Biron

  • 1Laboratoire central d'hématologie, hôpital Saint-Eloi, CHU Montpellier, 80, rue Augustin Fliche, 34295 Montpellier, France. schvedjf@aol.com

Gynecologie, Obstetrique & Fertilite
|June 29, 2002
PubMed
Summary

Progestogens, often combined with estrogens, can alter cardiovascular risk. While unopposed estrogens may offer benefits, progestogens can negate these effects, impacting coagulation and vessel health, particularly in hormone replacement therapy.

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Area of Science:

  • Endocrinology
  • Cardiovascular Science
  • Hematology

Context:

  • Estrogen therapy presents conflicting cardiovascular effects: increased risk with contraceptives versus potential benefits in hormone replacement therapy (HRT).
  • Progestogens are typically co-administered with estrogens, complicating the assessment of their independent effects on hemostasis and vascular function.
  • The precise role of progestogens alone on hemostasis and the vessel wall remains largely undetermined due to their infrequent use as monotherapy.

Purpose:

  • To elucidate the complex interactions between estrogens and progestogens on cardiovascular health, specifically focusing on hemostasis and vascular endothelium.
  • To investigate how progestogens modify the procoagulant and vascular effects of estrogens in combined therapies.
  • To reconcile conflicting epidemiological data on estrogen therapy by examining the influence of progestogens.

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Summary:

  • Progestogens alone exhibit minimal impact on the hemostatic system.
  • In combined oral contraceptives, progestogens modulate estrogen's effects on hemostasis and endothelium, potentially creating a prothrombotic trend, especially with third-generation progestogens.
  • Experimental data suggest progestogens inhibit beneficial estrogen effects, including reducing endothelium-dependent vasodilation and blunting estradiol's anti-atherosclerotic action on neointimal proliferation.

Impact:

  • Understanding progestogen's modulatory effects is crucial for interpreting clinical trial outcomes, such as the Heart and Estrogen/progestin Replacement Study (HERS), which showed no cardiovascular benefit.
  • This knowledge can inform the development of safer and more effective menopausal hormone therapies.
  • Highlights the need for careful consideration of progestogen type and dosage in estrogen-based therapies to optimize cardiovascular outcomes.