Short-term effects of high-dose 17β-estradiol in postmenopausal PD patients

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Abstract
Objective: To examine the effect of 17β-estradiol on the severity of the cardinal signs of PD in postmenopausal women. Background: Although the impact of estrogens on the manifestations of PD has not been subjected to rigorous study, their use is generally thought to be associated with a detrimental antidopaminergic effect. Methods: A double-blind, placebo-controlled, two-arm crossover study of high-dose transdermal 17β-estradiol was conducted in eight postmenopausal women with mild to moderate PD, all but one of whom exhibited levodopa-induced dyskinesias. Patients were randomized initially to either hormonal treatment or placebo for 2 weeks, followed by a 2-week washout period, and then another 2-week crossover treatment period. Active treatment employed four skin patches each releasing 0.1 mg of estradiol daily, replaced every 2 to 3 days. Results: After 10 days of treatment a significant reduction was observed in the antiparkinsonian threshold dose of IV levodopa. Mean duration and magnitude of the antiparkinsonian response to threshold or high doses of levodopa were unchanged, and dyskinesia scores were unaltered during 17β-estradiol treatment compared with placebo. No worsening in “on” time or motor ratings with estrogen treatment was documented. Conclusions: 17β-estradiol appears to display a slight prodopaminergic (or antiparkinsonian) effect without consistently altering dyskinesias. Standard postmenopausal replacement therapy with transdermal 17β-estradiol is likely to be well tolerated by many female parkinsonian patients.