Nephrology Dialysis Transplantation, Vol 14, Issue 5 1238-1243, Copyright © 1999 by Oxford University Press
J Matuszkiewicz-Rowinska, K Skorzewska, S Radowicki, A Sokalski, J Przedlacki, S Niemczyk, D Wlodarczyk, J Puk and M Switalski
Background. Impaired sexual function is an important
cause of depression in uraemic females. Hyperprolactinaemia is frequent,
and often associated with decreased serum oestradiol concentration, which
can significantly contribute to accelerated bone loss. The aim of the study
was to evaluate the effect of hormone replacement therapy (HRT) on sexual
function, serum 17{beta}-oestradiol and prolactin, and bone mineral
density (BMD) in pre-menopausal women undergoing haemodialysis.
Methods. Among 63 women on haemodialysis, aged 18-45
years, 23 with secondary amenorrhoea and serum oestradiol <30 pg/ml
were enrolled into the 1 year study. They were divided into: group I
(n=13) treated with transdermal oestradiol with cyclic
addition of norethisterone acetate, and control group II
(n=10). BMD was measured with dual energy X-ray
absorptiometry (DEXA). Results. No important changes
in sexual function and hormonal profile were observed in the control group,
whereas in all women from group I the treatment induced regular menses and
a marked improvement of libido and sexual activity. Serum
17{beta}-oestradiol increased after the first month from
20.5±11.7 to 46.8±13.6 pg/ml
(P<0.001) and remained at that level until the
end of the study, accompanied by a decrease of serum prolactin (from
1457±1045 to 691±116 mIU/ml after 12 months;
P<0.001). In group I, the treatment induced an
increase in BMD, although significant only in L2-L4
(P<0.05), whereas in group II a mild
insignificant decrease was observed. However, a comparison of BMD values
after 12 months in both groups revealed marked
(P<0.01-P<0.05)
differences at all studied sites. Conclusions.
Transdermal HRT allows sustained physiological serum oestradiol
concentrations in pre-menopausal women with oestrogen deficiency on
haemodialysis, with the restoration of regular menses and a marked
improvement in their sexual function. The treatment inhibits bone
demineralization and can play an important role in the prevention of early
osteoporosis in this group of patients. Keywords: bone
mineral density; end-stage renal failure; haemodialysis; hormone
replacement therapy; oestrogen deficiency; sexual function
PRELIMINARY REPORTS
The benefits of hormone replacement therapy in pre-menopausal women with oestrogen deficiency on haemodialysis
Department of Internal Medicine and Nephrology and Department of Gynecological Endocrinology, The Medical University of Warsaw, W. Banachi 1a, 02-097 Warsaw, Poland; Dialysis Unit, Wolomin Hospital, Wolomin, Poland; Dialysis Unit, Praski Hospital, Warsaw, Poland; Department of Nephrology, Plock Hospital, Plock, Poland; Corresponding author
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