North American Menopause Society
North American Menopause Society
September 27, 2019
1 min read

Clinical, lifestyle factors influence estradiol level when taking HT

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Estradiol levels among early and late postmenopausal women taking hormone therapy are influenced by several clinical and lifestyle factors, including BMI, surgical menopause, smoking, alcohol use and antifungal medication use, according to findings presented at the North American Menopause Society annual meeting.

Intira Sriprasert

“The beneficial effect of hormone therapy on atherosclerosis among postmenopausal women is related to achieved estradiol levels,” Intira Sriprasert, MD, a doctoral student in the department of preventive medicine at the Keck School of Medicine of the University of Southern California, told Endocrine Today. “Our study revealed that BMI, smoking, alcohol use, use of antifungal medication and kidney and liver function are significant determinants of estradiol level among postmenopausal women taking hormone therapy. These determinants of estradiol level are similar in both early and late postmenopausal women.”

Sriprasert and colleagues analyzed data from 256 healthy postmenopausal women participating in the Early Versus Late Intervention Trial With Estradiol (ELITE), a randomized controlled trial of 1 mg oral estradiol with or without vaginal progesterone, stratified by time since menopause. Within the cohort, 118 women were in early menopause (mean age, 55 years; mean time since menopause, 3.6 years), and 138 women were in late menopause (mean age, 64 years; mean time since menopause, 16 years). Researchers used mixed-effects linear models to identify factors associated with on-trial serum estradiol levels, assessed every 6 months, during a median follow-up of 4.8 years, adjusted for baseline estradiol level.

In the multivariable model, researchers found that higher BMI, higher creatinine, lower alanine transaminase, surgical menopause and alcohol use were associated with a higher estradiol level, whereas current smoking and antifungal medication use were associated with a lower estradiol level.

“Lifestyle factors, such as weight, smoking and alcohol use, affect the estradiol level, which indicate the treatment efficacy of hormone therapy,” Sriprasert said. “As these factors are modifiable, postmenopausal women should control their weight, refrain from smoking and alcohol use. Physicians prescribing hormone therapy should consider these factors and may adjust the appropriate treatment dose for each individual woman.” – by Regina Schaffer


Sriprasert I, et al. Abstract P-62. Presented at: North American Menopause Society Annual Meeting; Sept. 25-28, 2019; Chicago.

Disclosures: The NIH and the National Institute of Aging supported this study. Sriprasert reports no relevant financial disclosures.