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Comparison of Transdermal to Oral Estradiol Administration on Hormonal and Hepatic Parameters in Women with Premature Ovarian Failure

Departments of Obstetrics and Gynecology, Medical College of Virginia/Virginia Commonwealth University Richmond, Virginia 23298
Department of Medicine, Medical College of Virginia/Virginia Commonwealth University Richmond, Virginia 23298
The Department of Obstetrics and Gynecology, University of Medicine and Dentistry-New Jersey Medical School Newark, New Jersey 07103
The Department of Medicine, New York Hospital-Cornell Medical Center New York, New York 10021

Address requests for reprints to: Dr. K. A. Steingold, Department of Obstetrics and Gynecology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia 23298.

Five women with premature ovarian failure were studied in a randomized cross-over design to compare the biochemical effects of transdermal to oral estradiol administration when used in doses appropriate for endometrial preparation in a donor oocyte program. Patients randomly received increasing dosages of oral micronized or transdermal estradiol for 4 weeks, with progesterone added in the last 2 weeks, to mimic a normal hormonal cycle. Serum samples were assayed throughout treatment and compared to those from normally cycling premenopausal controls.

In general, serum estradiol remained within the normal range in both treatment groups, whereas peak serum estrone levels were 10-fold higher in the orally treated group than those in the transdermally treated group. Serum levels of sex hormone-binding globulin, thyroid binding globulin, and renin substrate were all significantly elevated by day 14 in the orally treated patients and unchanged in the transdermal subjects. While plasminogen was unaltered by either route of administration, antithrombin-III levels fell with both treatments. Changes in gonadotropin levels were similar in both groups, with suppression of FSH by the end of the simulated cycles, but not into the normal premenopausal range.

In conclusion, both estrogen replacement regimens provided near-normal serum estradiol profiles. However, despite the relatively high doses necessary to mimic a hormonally normal cycle, thetfansdermal route did not significantly alter the hepatic parameters studied, suggesting that this route of administration may have less adverse hepatic effects.

Received April 6, 1990.

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