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Human Reproduction Update, Vol.5, No.3 pp.200-204, 1999
© European Society of Human Reproduction and Embryology 1999; all rights reserved

Effects of progestins on cardiovascular diseases: the haemostatic system

UH Winkler

Department of Obstetrics and Gynaecology, Friedrich Ebert Hospital Neumünster, Friesentstr. 11, D-24531 Neumünster, Germany Tel: +49 4321 405 2061 Fax: 49 4321 405 2069

Abstract

The effect of progestin-only therapy on the haemostatic system has mainly been studied in premenopausal women. Although these studies are difficult to compare, most authors agree that there is no consistent pattern of effects on haemostasis. Oestrogen-progestin combinations have been extensively studied in pre- (combined oral contraceptives) and postmenopausal women (sequential and continuous combined hormone replacement therapy), but mostly with emphasis on the effects of oestrogens. Comparative studies into the differential effects of progestins in combined preparations are scarce. Based on these studies, there is evidence for modifying effects of progestins on oestrogen-induced changes, particularly on fibrinogen, factor VII and the fibrinolytic system. The modifying effects appear to vary among certain progestins, the variation being most likely due to differential effects on lipid metabolism. The clinical interpretation of steroid-induced effects on the haemostatic system is difficult. Retrospective analyses linking certain patterns of haemostatic regulation to the risk of venous or arterial vascular diseases are subject to bias, and no interventional studies are yet available. In the absence of such prospective studies and well-designed comparative studies, the available data do not support the notion of a superiority of certain progestins with regard to cardiovascular risks of combined preparations.

Keywords:cardiovascular diseases/haemostasis/hormone replacement therapy/oral contraceptives/progestins


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