Archives of Gynecology and Obstetrics

, Volume 283, Issue 5, pp 1045–1051 | Cite as

Effects of estradiol–drospirenone hormone treatment on carotid artery intima-media thickness and vertigo/dizziness in postmenopausal women

  • Hakan CoksuerEmail author
  • Mustafa Koplay
  • Fatih Oghan
  • Cengiz Coksuer
  • Nadi Keskin
  • Olcay Ozveren
General Gynecology



To investigate the effects of Angeliq on hormonal, metabolic, biochemical and cardiovascular profile, carotid intima-media thickness (CIMT) and vertigo/dizziness symptoms in postmenopausal women.


Angeliq is a drug used for hormone replacement therapy that composed of drospirenone 2 mg and estradiol 1 mg. Thirty-two postmenopausal women were recruited for the study. All women were evaluated using personal interview, medical examination and carotid artery ultrasound. They were questioned specifically about vertigo/dizziness experienced. Participants were randomly submitted to oral daily treatment with Angeliq. The duration of the study was 6 months and the participants were studied in basal condition and after 6 months of the therapy.


Follicle-stimulating hormone was significantly higher and estradiol was significantly lower in before therapy (BT) than in after therapy (AT) (p < 0.001). No differences in fasting glucose, CRP and WBC values, and lipid–lipoprotein profile were detected between the groups. The systolic and diastolic blood pressures and heart rate were also significantly higher in BT than in AT (p < 0.05). A significant (p < 0.001) difference in CIMT (0.51 ± 0.04 vs. 0.49 ± 0.03 mm) was found between BT and AT. Seven of 32 patients (22%) had vertigo/dizziness symptoms before treatment. After 6 months, none of the patients showed complaints of vertigo/dizziness.


Oral daily treatment with Angeliq reduces CIMT and climacteric complaints including vertigo/dizziness in postmenopausal women. They may relate to anti-androgenic and anti-mineralocorticoid effects of Angeliq, respectively.


Cardiovascular disease Carotid intima-media thickness Drospirenone Menopause Vertigo/dizziness 



After therapy


Before therapy


Body mass index


Coronary heart disease


Carotid intima-media thickness


C-reactive protein


Diastolic blood pressure






Follicle-stimulating hormone


Hormone replacement therapy


High-density lipoprotein


Postmenopausal women


Systolic blood pressure


Total cholesterol




Low-density lipoprotein


White blood cells count


Conflict of interest statement

There is no conflict of interest between the authors.


  1. 1.
    Van der Schouw Y, Van der Graaf Y, Steyerberg EW, Eijkemans MJC, Banga JD (1996) Age at menopause as a risk factor for cardiovascular mortality. Lancet 347:714–718PubMedCrossRefGoogle Scholar
  2. 2.
    McCrohon JA, Adams MR, McCredie RJ et al (1996) Hormone replacement therapy is associated with improved arterial physiology in healthy postmenopausal women. Clin Endocrinol 45:435–441CrossRefGoogle Scholar
  3. 3.
    Espeland MA, Applegate W, Furberg CD et al (1995) Oestrogen replacement therapy and progression of intimal-thickness in the carotid arteries of postmenopausal women. Am J Epidemiol 142:1011–1019PubMedGoogle Scholar
  4. 4.
    Bots ML, Hofman A, de Bruijn AM, de Jong PTVM, Grobbee DE (1993) Isolated systolic hypertension and vessel wall thickness of the carotid artery: The Rotterdam Elderly Study. Arterioscler Thromb 13:64–69PubMedGoogle Scholar
  5. 5.
    Stevenson JC (2005) Menopausal hormone therapy. In: Wenger NK, Collins P (eds) Women and heart disease. Taylor and Francis, London, pp 375–390Google Scholar
  6. 6.
    Hsia J, Langer RD, Manson ME et al (2006) Conjugated equine estrogens and coronary heart disease. Arch Intern Med 166:357–365PubMedCrossRefGoogle Scholar
  7. 7.
    Teichmann A (2003) Pharmacology of estradiol valerate/dienogest. Climacteric 6(Suppl. 2):17–23PubMedGoogle Scholar
  8. 8.
    Foidart JM, Wuttke W, Bouw GM, Gerlinger C, Heithecker R (2000) A comparative investigation of contraceptive reliability. Eur J Contracept Reprod Health Care 5:124–134PubMedCrossRefGoogle Scholar
  9. 9.
    Preston RA, White WB, Pitt B et al (2005) Effects of drospirenone/17-β estradiol on blood pressure and potassium balance in hypertensive postmenopausal women. Am J Hypertens 18:797–804PubMedCrossRefGoogle Scholar
  10. 10.
    Carretero OA, Oparil S (2000) Essential hypertension. Part I. definition and etiology. Circulation 101:329–335PubMedGoogle Scholar
  11. 11.
    Ribot C, Bonneu M, Pouillès J-M, Trèmollieres F (1992) Assessment of the risk of postmenopausal osteoporosis using clinical risk factors. Clin Endocrinol (Oxf) 36:225–258CrossRefGoogle Scholar
  12. 12.
    Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R (1986) Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 74:1399–1406PubMedGoogle Scholar
  13. 13.
    Colditz GA, Willet WC, Stampfer MJ, Rosner B, Spiezer FK, Hennekers CH (1987) Menopause and the risk of coronary heart disease in women. New Engl J Med 316:1105–1110PubMedCrossRefGoogle Scholar
  14. 14.
    Stampfer MI, Colditz GA (1991) Estrogen replacement and coronary heart disease: a quantitative assessment of the epidemiologic evidence. Prev Med 20:47–63PubMedCrossRefGoogle Scholar
  15. 15.
    Barret-Connor E, Bush TL (1991) Estrogen and coronary artery disease in women. J Am Med Assoc 265:1861–1867CrossRefGoogle Scholar
  16. 16.
    Vidovic IP, Demarin V, Grubisic G, Kuna K, Huzjan AL (2001) Carotid artery intima thickness and flow velocity after discontinuation of hormone replacement therapy in postmenopausal women: follow-up study. Croat Med J 42:54–57PubMedGoogle Scholar
  17. 17.
    Stevenson JC (2009) Hormone replacement therapy and cardiovascular disease revisited. Menopause Int 15:55–57PubMedCrossRefGoogle Scholar
  18. 18.
    Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B (1992) Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 117:1016–1037PubMedGoogle Scholar
  19. 19.
    Adams MR, Register TC, Golden DL, Wagner JD, Williams JK (1997) Medroxyprogesterone acetate antagonizes inhibitory effects of conjugated equine estrogens on coronary artery atherosclerosis. Arterioscler Thromb Vasc Biol 17:217–221PubMedGoogle Scholar
  20. 20.
    Stevenson J (1995) The metabolic and cardiovascular consequences of hormone replacement therapy. Br J Clin Pract 49:87–90PubMedGoogle Scholar
  21. 21.
    Taskinen MR, Puolakka J, Pyorala T, Luotola H, Bjaorn M, Kaarianen J et al (1996) Hormone replacement therapy lowers plasma Lp(a) concentrations. Comparison of cyclic transdermal and continuous estrogen_/progestin regimens. Arterioscler Thromb Vasc Biol 16:1215_/21Google Scholar
  22. 22.
    Sack MN, Rader DJ, Cannon RO (1994) Oestrogen and inhibition of oxidation of low-density lipoproteins in postmenopausal women. Lancet 343:269–270PubMedCrossRefGoogle Scholar
  23. 23.
    Scarabin PY, Alhenc-Gelas M, Oger E, Plu-Bureau G (1999) Hormone replacement therapy and circulating ICAM-1 in postmenopausal women a randomised controlled trial. Thromb Haemost 81:673–675PubMedGoogle Scholar
  24. 24.
    Oelkers W, Foidart JM, Dombrovicz N, Welter A, Heithecker R (1995) Effects of a new oral contraceptive containing an antimineralocorticoid progestogen, drospirenone, on the rennin-aldosterone system, body weight, blood pressure, glucose tolerance, and lipid metabolism. J Clin Endocrinol Metab 80:1816–1821PubMedCrossRefGoogle Scholar
  25. 25.
    The Writing Group for the PEPI Trial (1995) Effects of oestrogen or oestrogen:progestin regimens on heart disease risk factors in postmenopausal women. The postmenopausal oestrogen:progestin interventions (PEPI) trial. J Am Med Assoc 273:199–208CrossRefGoogle Scholar
  26. 26.
    McCrohon JA, Adams MR, McCredie RJ et al (1996) Hormone replacement therapy is associated with improved arterial physiology in healthy postmenopausal women. Clin Endocrinol 45:435–441CrossRefGoogle Scholar
  27. 27.
    Palacios S, Foidart JM, Genazzani AR (2006) Advances in hormone replacement therapy with drospirenone, a unique progestogen with aldosterone receptor antagonism. Maturitas 55:297–307PubMedCrossRefGoogle Scholar
  28. 28.
    Wakatsuki A, Okatani Y, Ikenoue N, Fukukaya T (2002) Effect of medroxyprogesterone acetate on vascular inflammatory markers in postmenopausal women receiving estrogen. Circulation 105:1436–1439PubMedCrossRefGoogle Scholar
  29. 29.
    Stanczyk FZ (2002) Pharmacokinetics and potency of progestins used for hormone replacement therapy and contraception. Rev Endocr Metab Disord 3:211–224PubMedCrossRefGoogle Scholar
  30. 30.
    Schurmann R, Holler T, Benda N (2004) Estradiol and drospirenone for climacteric symptoms in postmenopausal women: a double blind, randomized, placebo-controlled study of the safety and efficacy of three dose regimens. Climacteric 7:189–196PubMedCrossRefGoogle Scholar
  31. 31.
    Campisi R, Nathan L, Pampaloni MH, Schöder H, Sayre JW, Chaudhuri G, Schelbert HR (2002) Noninvasive assessment of coronary microcirculatory function in postmenopausal women and effects of short-term and long-term estrogen administration. Circulation 105:425–430PubMedCrossRefGoogle Scholar
  32. 32.
    Duvernoy CS, Rattenhuber J, Seifert-Klauss V, Bengel F, Meyer C, Schwaiger M (2001) Myocardial blood flow and flow reserve in response to short-term cyclical hormone replacement therapy in postmenopausal women. J Gender Specific Med 4:21–27Google Scholar
  33. 33.
    Duvernoy C, Martin J, Briesmiester A, Bargardi A, Muzik O, Mosca L (2004) Myocardial blood flow and flow reserve in response to hormonetherapy in postmenopausal women with risk factors for coronary disease. J Clin Endocrinol Metab 89:2783–2788PubMedCrossRefGoogle Scholar
  34. 34.
    Schriffrin EL (2006) Effects of aldosterone on the vasculature. Hypertension 47:312–318CrossRefGoogle Scholar
  35. 35.
    Pitt B, Remme W, Zannad F et al (2003) Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 348:1309–1321PubMedCrossRefGoogle Scholar
  36. 36.
    The Women’s Health Initiative Steering Committee (2004) Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA 291:1701–1712CrossRefGoogle Scholar
  37. 37.
    Craven TE, Ryu JE, Espeland MA, Kahl FR, McKinney WM, Toole JF (1990) Evaluation of the association between carotid artery atherosclerosis and coronary artery stenosis: a case control study. Circulation 82:1230–1242PubMedGoogle Scholar
  38. 38.
    Punnonen RH, Jokela HA, Dastiden PS, Wevelo M, Laippale PJ (1995) Combined estrogen-progestin replacement therapy prevents atherosclerosis in postmenopausal women. Maturitas 21:179–187PubMedCrossRefGoogle Scholar
  39. 39.
    Bonithon-Kopp C, Toubout PJ, Berr C, Leroux C, Mainard F, Courbon D (1996) Telation of intima-media thickness to atherosclerotic plaques in carotid arteries. The vascular aging (E.U.A.) study. Arterioscler Thromb Vasc Biol 16:310–316PubMedGoogle Scholar
  40. 40.
    Bonithon-Kopp C (1997) Prevalence of and risk factors for intimamedia thickening: a literature review. In: Touboul P-J, Crouse JR, (eds), Intima-media thickness and atherosclerosis: predicting the risk? Parthenon Publishing Group New York, NY, pp 27–44Google Scholar
  41. 41.
    O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr (1999) Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular health study collaborative research Group. N Engl J Med 340:14–22PubMedCrossRefGoogle Scholar
  42. 42.
    Zanchetti A (1996) Antiatherosclerotic effects of antihypertensive drugs: recent evidence and ongoing trials. Clin Exp Hypertens 18:489–499PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Hakan Coksuer
    • 1
    Email author
  • Mustafa Koplay
    • 2
  • Fatih Oghan
    • 3
  • Cengiz Coksuer
    • 5
  • Nadi Keskin
    • 1
  • Olcay Ozveren
    • 4
  1. 1.Department of Obstetrics and Gynecology, Faculty of Medicine, School of MedicineDumlupınar UniversityKutahyaTurkey
  2. 2.Department of Radiology, School of MedicineDumlupinar UniversityKutahyaTurkey
  3. 3.Department of Otorhinolaryngology, School of MedicineDumlupinar UniversityKutahyaTurkey
  4. 4.Department of Cardiology, School of MedicineDumlupinar UniversityKutahyaTurkey
  5. 5.Cizre State HospitalKutahyaTurkey

Personalised recommendations