Therapy
Meta-analysis of 11 trials finds medroxyprogesterone acetate raises Lp(a) while lowering ApoA-I in postmenopausal women (Prostaglandins Other Lipid Mediat 2025)
Original title: The effect of medroxyprogesterone acetate on apolipoproteins and lipoprotein(a) concentrations in postmenopausal women: A meta-analysis of randomized controlled trials
This meta-analysis of randomised controlled trials pooled 11 publications assessing the effect of medroxyprogesterone acetate (MPA), used in hormone replacement therapy, on apolipoprotein and Lp(a) concentrations in healthy postmenopausal women. MPA significantly lowered ApoA-I (weighted mean difference -8.70 mg/dL, 95% CI -12.80 to -4.59, P < 0.001) and significantly raised Lp(a) (weighted mean difference 1.36 mg/dL, 95% CI 0.10 to 2.63, P = 0.033), with a non-significant increase in ApoB (weighted mean difference 0.57 mg/dL, 95% CI -1.25 to 2.40, P = 0.539). The Lp(a)-raising and ApoA-I-lowering effects were more pronounced at the 5 mg/day dose than at 2.5 mg/day. The findings suggest MPA's lipid profile effects, including a modest but significant Lp(a) increase, deserve consideration when weighing hormone therapy regimens in postmenopausal women.
Original abstract
Background And Aim: In view of the favorable effect of hormone replacement therapy (HRT) on the lipid profile in postmenopausal women, and the discrepancies that exist on the effect of medroxyprogesterone acetate (MPA) on lipoprotein concentrations and cardiovascular disease (CVD) risk, we conducted this meta-analysis of randomized controlled trials (RCT) to assess the efficacy of MPA on apolipoprotein and lipoprotein(a) concentrations in healthy postmenopausal women.
Methods: A systematic search was conducted across multiple databases, including for English-language papers published up to September 2023 comparing the effect of MPA on ApoA-I, Apo-AII, and Lp(a) levels with those of a control group. A meta-analysis was conducted using a random-effects model, reporting the results as the weighted mean difference (WMD) with a 95 % confidence interval (CI).
Results: The current meta-analysis included 11 publications. the comprehensive findings indicated a noteworthy reduction in ApoA-I (WMD:-8.70 mg/dL,95 %CI: -12.80, -4.59,P<0.001), a significant increase in Lp(a) concentrations (WMD: 1.36 mg/dL, 95 % CI: 0.10, 2.63, P=0.033), and a non-significant increase in ApoB concentrations (WMD: 0.57 mg/dL, 95 %CI: -1.25, 2.40, P=0.539) after the administration of MPA in postmenopausal women. In addition, a significant reduction in ApoB levels was identified in studies with a mean participant BMI ≥25 kg/m2 (WMD: -4.94 mg/dL, 95 %CI: -5.71 to -4.18,P< 0.001) and a greater impact on ApoA-1 and Lp(a) levels was observed in trials with doses of 5 mg/day compared with 2.5 mg/day.
Conclusion: MPA administration resulted in a significant increase in Lp(a) and decrease in ApoA-I levels and a non-significant increase in ApoB levels in healthy postmenopausal women.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.