Efficacy of oral versus transdermal estrogen therapy on cardiovascular and lipid parameters among postmenopausal women: a systematic review and meta-analysis of randomized clinical trials

Doma M.; Loayza Pintado J.J.; Atwal A.; Jesus A.L.; Zahrawi F.M.; Saleh I.; El Gammal A.; Maharm Z.; Ramadan A.; Vlassis B.; Ali M.S.; Aljamali M.K.; Pandey R.; Mefti M.; Badran M.; Aslam M.; Subedi A.; Shah J.; Aiash H. · Menopause (2026) · DOI: 10.1097/gme.0000000000002637

Resumen

Importance: – Menopause is characterized by significant physiological changes, including cardiovascular and hormonal alterations. Estrogen therapy is a critical intervention for managing menopausal symptoms and preventing long-term complications. Understanding the differences between the estrogen therapy administration routes is essential for optimizing treatment strategies. Objective: – This study aimed to compare oral and transdermal routes of estrogen therapy among postmenopausal women and assess changes from baseline in key cardiovascular and lipid parameters, including systolic and diastolic blood pressure, heart rate, total cholesterol, low and high-density lipoprotein, and triglyceride levels. Evidence review: – PubMed, Scopus, Web of Science, and ClinicalTrials. gov were searched for randomized clinical trials comparing oral and transdermal estrogen therapy in postmenopausal women. Pooled mean differences (MDs) with 95% CIs were estimated using a random effects model. Statistical analyses were performed using R version 4.3.2. Findings: – Eight randomized clinical trials, with a total of 885 participants, were included. Of these participants, 453 (51.2%) received oral estrogen therapy. Participants receiving oral estrogen therapy had a higher mean change in high-density lipoprotein levels (MD=3.48 mg/dL; 95% CI: 1.54-5.43; P<0.01) coupled with a significant rise in mean triglyceride levels (MD=19.82; 95% CI: 6.85-32.78; P<0.01), compared with participants receiving transdermal estrogen therapy. There were no significant differences in the mean changes from baseline in the systolic and diastolic blood pressure, heart rate, total cholesterol, and low-density lipoprotein levels. Conclusions and relevance: – Compared with transdermal estrogen therapy, oral estrogen therapy was associated with a greater increase in high-density lipoprotein levels in postmenopausal women. However, this was associated with a greater increase in the triglyceride levels. This suggests that the choice of estrogen therapy route should be individualized, considering the patients’ baseline hormonal and metabolic parameters, particularly lipid profiles.

Instituciones: Universidad de San Martín de Porres