Short answer: Estrogen pills can. Estrogen labels list increased triglycerides as an effect, and in the PEPI trial every hormone regimen raised average triglycerides by about 11 to 14 mg/dL compared with placebo. A pooled review of 248 studies found oral estrogens raised triglycerides while estradiol through the skin lowered them. For women who already have high triglycerides, the labels warn of rises that can lead to pancreatitis.
The Premarin and estradiol tablet labels describe the effect of estrogens on blood fats: higher HDL ("good") cholesterol, lower LDL cholesterol, and higher triglycerides. Both list increased triglycerides among side effects.
Both labels also carry a warning: in women with pre-existing high triglycerides (hypertriglyceridemia), estrogen therapy may be associated with rises in triglycerides leading to pancreatitis. The Premarin label says to stop estrogen if severe hypertriglyceridemia occurs, and to consider stopping if pancreatitis occurs.
The Postmenopausal Estrogen/Progestin Interventions (PEPI) trial gave 875 healthy women aged 45 to 64 placebo or one of four oral regimens for 3 years: conjugated estrogens 0.625 mg alone, or with medroxyprogesterone (cyclic or daily) or with cyclic micronized progesterone.
| Measure | Change on hormone therapy |
|---|---|
| Triglycerides | Up 11.4 to 13.7 mg/dL across all active regimens |
| LDL cholesterol | Down 14.5 to 17.7 mg/dL across all active regimens |
| HDL cholesterol | Up most with estrogen alone (5.6 mg/dL) and with cyclic micronized progesterone (4.1 mg/dL); up 1.2 to 1.6 mg/dL with medroxyprogesterone; down 1.2 mg/dL on placebo |
A 2001 pooled review by Godsland looked at 248 studies of 42 hormone regimens published from 1974 to 2000. All estrogen-alone regimens raised HDL and lowered LDL and total cholesterol. Oral estrogens raised triglycerides, while transdermal estradiol (through the skin) lowered them. The progestogen added also mattered: different types blunted the estrogen-driven rise in HDL and triglycerides to different degrees, with dydrogesterone, medrogestone and progesterone among those with the least effect.
This is a pooled review of mostly older and smaller studies, not one head-to-head trial, and the review itself said the clinical meaning of these lipid changes still needed work.
For most women, the triglyceride change in PEPI was modest. It matters more for women whose triglycerides are already high, which is the group the label warning is about. The labels give no number for what counts as high. Their patient information also lists high blood pressure, high cholesterol, diabetes, being overweight and tobacco use as things that raise the chance of heart disease, which is part of why lipids are read alongside the rest of the picture. The choice of product and route is made with the prescriber, often with a recent lipid panel in hand. Dose Track can keep lipid results next to the hormone doses and the date each product was started.
Read more on Dose Track: Lipid panel · Pancreatitis · Premarin side effects · Cholesterol · Transdermal patch