The effects of hormone therapy on pulmonary function tests in postmenopausal women
Introduction
Data from recent researches demonstrate that postmenopausal hormone therapy (HT) constituting use of estrogen and progesterone combination for more than 5 years increased relative risks related to invasive breast cancer and cardiovascular disease, while decreasing relative risks associated with colorectal cancer and hip fracture [1], [2]. Although the discussions shifted the attention to concerned organs, the question of how different regimens used in postmenopausal HT affect other organs continues to attract the attention of many researchers.
It has been known for some time that sex steroids can affect women’s pulmonary functions. While the prevalence of asthma in the prepubertal period is higher among men than among women, the rate of female asthma cases to male asthma cases rises to 3:1 in the 20–50 age group [3], [4], [5]. There are studies reporting that there is a deterioration in asthma symptoms and pulmonary function test values before and during menstruation, but that after beginning to use drugs containing progesterone (P) and/or estrogen (E) cases started to feel better and their need for anti-asthmatic drugs lessened [6], [7], [8], [9], [10]. It was shown that those who used combined oral contraceptive (COC) had statistically significantly higher total pulmonary capacity than those who did not use COC and that COC reduced the premenstrual decreases in pulmonary functions of asthmatic women [11]. It was claimed that combined oral contraceptives prevented changes that occurred in plasma estrogen and progesterone levels during menstrual cycle and the asthma exacerbation thereof [11], [12]. However, there are also publications reporting that the use of COC did not have any apparent effect on pulmonary functions of asthmatic cases [13], [14].
Studies examining the relation between HT and pulmonary function tests (PFT) in postmenopausal women contain contradictory results. Studies carried out with a low number of asthma cases and used only E for HT reported that E affected PFT negatively [15], [16], [17]. Another study conducted with cross-over mechanism showed that in asthma cases using E for HT interruption or resumption of the drug did not affect PFT [18]. One of the publications examining the effects of combined HT use on pulmonary functions, that included an extensive case series but were retrospective and cross-sectional, reported that HT use increased asthma incidence, whereas another stated that HT had restorative effect on PFT (FEV1, FVC) [19], [20].
Our literature scan did not reveal any prospective clinical study that compared with the control group the effects of sex steroids (E, continuous E+P, cyclic E+P) used in various forms for the purpose of HT in the postmenopausal period on pulmonary functions. Therefore we planned to design a prospective and controlled clinical research to evaluate, before and after the treatment, the pulmonary functions of women who were administered various forms of HT and those who did not receive any drug.
Section snippets
Methods
The study was carried out in Afyon Kocatepe University School of Medicine between February 2002 and May 2003. Of those who applied to the menopause polyclinic, cases at 60 years of age or below, who have not had periods for at least 1 year and who have not had any form of HT before were included into the study. In hormone profile evaluation, hormonal measurements of plasma estradiol (E2) levels below 30 pg/ml and follicle-stimulant hormone (FSH) levels over 40 IU/ml were accepted as congruous
Results
Age, menopause period and body mass index of the cases are presented in Table 1. Mean age and menopause period of the group receiving cyclic E+P (Group IV) were lower than those in other groups (P<0.001). Women in this group were those whose menopause started at earlier ages compared to women in other groups and they wanted to have menses for some more time. There was no statistically significant difference between groups in terms of body mass index (Table 1).
Hormone profiles of the cases, both
Discussion
In this study we found significant increases in measured and percent predicted FEV1 and FVC values after HT application in comparison to basal values, in groups receiving HT, particularly the one that used continuous combined estrogen and progesterone (Group III) (Table 3, Table 4). Literature scan revealed publications investigating the relation between use of HT regimens and PFT in postmenopausal women, but these had different study mechanisms. Carlson et al. analyzed data from 2353 women
Conclusions
In conclusion, an evident level of improvement was found in pulmonary function tests (FEV1 and FVC) with the use of especially continuous combined HT (E+P). Use of continuous combined HT regimen may prove useful in postmenopausal cases, particularly those with pulmonary problems.
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