Effects of transdermal versus oral hormone replacement therapy in postmenopause: a systematic review
Goldštajn M.Š. Mikuš M. Ferrari F.A. Bosco M. Uccella S. Noventa M. Török P. Terzic S. Laganà A.S. Garzon S.
June 2023Springer Science and Business Media Deutschland GmbH
Archives of Gynecology and Obstetrics
2023#307Issue 61727 - 1745 pp.
Purpose: To summarize available evidence comparing the transdermal and the oral administration routes of hormone replacement therapy (HRT) in postmenopausal women. Methods: We performed a systematic review of the literature on multiple databases between January 1990 and December 2021. We included randomized controlled trials and observational studies comparing the transdermal and oral administration routes of estrogens for HRT in postmenopausal women regarding at least one of the outcomes of interest: cardiovascular risk, venous thromboembolism (VTE), lipid metabolism, carbohydrate metabolism, bone mineral density (BMD), and risk of pre-malignant and malignant endometrial lesions, or breast cancer. Results: The systematic literature search identified a total of 1369 manuscripts, of which 51 were included. Most studies were observational and of good quality, whereas the majority of randomized controlled trials presented a high or medium risk of bias. Oral and transdermal administration routes are similar regarding BMD, glucose metabolism, and lipid profile improvements, as well as do not appear different regarding breast cancer, endometrial disease, and cardiovascular risk. Identified literature provides clear evidence only for the VTE risk, which is higher with the oral administration route. Conclusions: Available evidence comparing the transdermal and oral administration routes for HRT is limited and of low quality, recommending further investigations. VTE risk can be considered the clearest and strongest clinical difference between the two administration routes, supporting the transdermal HRT as safer than the oral administration route.
Administration route , Cancer , Cardiovascular risk , Hormone replacement therapy , Metabolism , Postmenopausal , Venous thromboembolism
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Department of Obstetrics and Gynecology, University Hospital Centre, Zagreb, Croatia
School of Medicine, University of Zagreb, Zagreb, Croatia
Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
Department of Women and Children’s Health, Clinic of Gynecology and Obstetrics, University of Padua, Padua, Italy
Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, 010000, Kazakhstan
Unit of Gynecologic Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
Department of Obstetrics and Gynecology
School of Medicine
Department of Obstetrics and Gynecology
Department of Women and Children’s Health
Faculty of Medicine
Department of Medicine
Unit of Gynecologic Oncology
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