National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK.
Climacteric. 2009;12 Suppl 1:86-90. doi: 10.1080/13697130903007389.
Hormone replacement therapy (HRT) can be administered orally and non-orally. Providing equivalent doses are given, all forms of HRT can equally relieve menopausal symptoms and prevent bone loss and osteoporosis. Different routes of administration will have differing metabolic effects, with oral HRT producing a hepatic first-pass effect not seen with non-oral HRT. The first-pass effect can produce benefits including larger reductions in low density lipoprotein cholesterol, lipoprotein(a) and insulin resistance, and larger increases in high density lipoprotein cholesterol. Unwanted effects are seen in increases in triglycerides and in coagulation activation. Cardiovascular effects of oral and transdermal HRT appear to be fairly similar, with improvements in vascular endothelial function, angiotensin-converting-enzyme activity, and in most markers of inflammation. There is a paucity of studies on the effects of transdermal HRT on cardiovascular outcomes, but the few data available suggest similar effects to oral HRT, and dose rather than route of administration is probably more important in this respect. Oral HRT may be preferred in women with evidence of insulin resistance, such as in metabolic syndrome or maturity-onset diabetes mellitus. Transdermal HRT may be preferred in women with coagulation disturbances. But, for the majority of women, personal preference should determine their choice of HRT route.
激素替代疗法（HRT）可以口服和非口服给药。给予等效剂量时，所有形式的 HRT 都可以同样缓解更年期症状并预防骨质流失和骨质疏松症。不同的给药途径会产生不同的代谢作用，口服 HRT 会产生非口服 HRT 所没有的肝脏首过效应。首过效应可带来包括降低 LDL 胆固醇、脂蛋白(a)和胰岛素抵抗的更大幅度，以及提高 HDL 胆固醇的更大幅度。但也会出现不良影响，如甘油三酯增加和凝血激活。口服和透皮 HRT 的心血管作用似乎相当相似，可改善血管内皮功能、血管紧张素转换酶活性以及大多数炎症标志物。关于透皮 HRT 对心血管结局的影响的研究很少，但现有少数数据表明其作用与口服 HRT 相似，而且在这方面，剂量而不是给药途径可能更为重要。对于有胰岛素抵抗证据的妇女，如代谢综合征或成年发病型糖尿病，口服 HRT 可能更受欢迎。对于有凝血障碍的妇女，透皮 HRT 可能更受欢迎。但是，对于大多数妇女来说，个人偏好应该决定她们选择 HRT 途径。
