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Transdermal HT appeared superior to oral HT
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20th Annual North American Menopause Society Meeting
Significant differences were found in hormonal bioavailability between oral and transdermal hormone therapy — a finding with implications in clinical efficacy, potential side effects and risks, according to data presented by Michael P. Goodman, MD, at the 20th Annual North American Menopause Society Meeting, held in San Diego.
“The risk attributed to estrogens, especially venous thromboembolism, stroke and lowering of testosterone levels are all the result of oral products and not the low-dose transdermal HT product,” Goodman, medical director of the Menopausal Clinic of the Caring for Women Wellness Center in Davis, Calif., told Endocrine Today.
In a review of 48 studies, Goodman and colleagues assessed whether or not transdermal HT is superior to oral HT in women of both the perimenopausal state and the postmenopausal state.
Data indicated transdermal therapy estradiol-17 beta (E2) had minimal effects on total and free concentrations of testosterone, thyroxine, cortisol and binding proteins when compared with oral HT. Data further indicated that oral HT benefitted lipid profiles in postmenopausal women, which led to an increase in HDL, a decrease in LDL and an increase in triglyceride levels.
However, transdermal HT may have a “favorable effect on triglyceride levels while maintaining, albeit to a slightly lesser degree, oral HT’s beneficial effects on LDL and HDL,” according to the researchers.
In one of the studies included in the trial, the Women's Health Initiative study, data suggested oral estrogen/progestin HT assigned to women aged 50 to 79 years was associated with a significant increase in coronary heart disease, thrombogenic stroke and venous thromboembolism, and a similar increase was found for stroke and VTE for estrogen only. This, and other studies, however, were performed on relatively high doses of oral HT; this increased risk potential has not been observed in studies utilizing low-dose transdermal E2, according to Goodman.
The researchers concluded that transdermal therapy estradiol-17 beta (E2) was superior to oral therapy in all domains studied. Transdermal therapy estradiol-17 beta (E2) maintained high effectiveness at all doses and was better tolerated, according to an abstract.
"Clinicians should not be afraid to prescribe estrogens, especially in women near menopause, in the pre-perimenopause state and in the immediate postmenopausal state," Goodman said. "Estrogens have received a bad name because all of the earlier studies proclaiming risk were performed exclusively with oral estrogens." – by Jennifer Southall
The reanalysis of the WHI by Roussea in 2007 suggested that HT given to younger symptomatic women (aged 60 years or younger and within 10 years of menopause) was associated with decreased mortality, however, VTE was increased with a low absolute risk of VTE of less than 1 per 500. In specific clinical settings, the choice of the transdermal route of administration of estrogens may offer benefits and added safety as there is some data that suggests that estrogen delivered transdermally may not increase the likelihood of clotting for women who are at mild risk.
– JoAnn V. Pinkerton, MD
Professor, Obstetrics and Gynecology
Director, Midlife Health Center and Division, University of Virginia
For more information:
- Goodman MP. LB-9. Presented at: the 20th Annual North American Menopause Society Meeting; Sept. 30-Oct. 3, 2009; San Diego.
