The effect of medroxyprogesterone acetate plus conjugated equine estrogens on lipoprotein(a) and apolipoprotein concentrations in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE

The influence of medroxyprogesterone acetate plus conjugated equine estrogens (MPA/CEE) on apolipoproteins and lipoprotein(a) levels has been vastly studied with inconsistent results. These inconsistencies could be attributed to several factors, such as the characteristics of the included participants and dosage and duration of intervention, among others. This study was conducted to determine the impact of MPA/CEE on the lipoprotein(a) and apolipoprotein concentrations in the postmenopausal women through a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

A comprehensive search was conducted across multiple databases for relevant RCTs up to April 2025, and a random-effects model was used to conduct a meta-analysis, with results presented as the weighted mean difference (WMD) along with a 95% confidence interval (CI). Subgroup and sensitivity analyses were further conducted to find potential sources of heterogeneity.

RESULTS

The current meta-analysis included 27 RCTs with 37 study arms. The study results revealed an increase in Apolipoprotein A1 (WMD: 12.42 mg/dL, 95%CI: 9.31, 15.52, P < 0.001), as well as a decline in Apolipoprotein B (WMD: -6.84 mg/dL, 95%CI: -8.28, -5.39, P < 0.001) and lipoprotein(a) (WMD: -5.12 mg/dL, 95%CI: -6.58, -3.65, P < 0.001) concentrations following MPA/CEE administration in postmenopausal women.

CONCLUSIONS

This meta-analysis indicates that MPA/CEE has a beneficial impact in the levels of atherogenic lipoproteins, which be correlated with a reduction in cardiovascular disease risk.