Depot-Medroxyprogesterone Acetate and Endothelial Function Before and After Acute Oral, Vaginal, and Transdermal Estradiol Treatment

Young women using depot-medroxyprogesterone acetate (DMPA) contraception have low circulating estrogen and elevated synthetic progestin. Low estrogen and certain progestins have been shown to impact endothelial function even in young healthy women. The purpose of this study was to investigate how DMPA affects endothelial function and serum biomarkers of cardiovascular risk prior to and after acute oral, vaginal, and transdermal estradiol treatments. Seven young women participated on three study days during a normal 12 week DMPA cycle; during weeks three, six, and nine. An additional eight young women participated on six separate days during a 12 week DMPA cycle; three times on DMPA-only and three times when using DMPA plus acute estradiol treatments. Wall tracking of high-resolution ultrasound images of the brachial artery were used during endothelium-dependent flow mediated dilation (EDFMD) and nitroglycerin administration to test endothelial function. Serum samples were analyzed for cardiovascular indices at each study visit. All estradiol treatments increased EDFMD compared to DMPA-only (P\u3c 0.001). EDFMD was not different among DMPA-only treatment days. Endothelium-independent vasodilation and cholesterol levels were unchanged across DMPA-only and DMPA plus estradiol cycles. These data suggest that acute estradiol treatments improve EDFMD in young hypoestrogenic women using DMPA