Whedon James M, KizhakkeVeettil Anupama, Rugo Nancy A, Kieffer Kelly A
1 University Health System, Southern California University of Health Sciences , Whittier, California.
2 Department of Oriental Medicine, Southern California University of Health Sciences , Whittier, California.
J Womens Health (Larchmt). 2017 Jan;26(1):18-28. doi: 10.1089/jwh.2015.5628. Epub 2016 Sep 7.
Proponents of bioidentical estrogens claim that they are superior for treating menopausal symptoms, including depressive symptoms. Small trials examining the effects of bioidentical estrogens on depressive symptoms show conflicting results. We conducted a systematic review to assess the effectiveness and safety of bioidentical estrogens for treatment of depressive symptoms in peri- and postmenopausal women.
We searched the scientific literature for randomized controlled trials of at least 4 weeks duration, comparing bioidentical estrogen with placebo for depressive symptoms in menopausal women. The main outcome measure was improvement in depressive symptoms on a validated scale.
We found 12 clinical trials that met inclusion criteria, two of which contained insufficient data for quantitative analysis. In the 10 studies (inclusive of 1208 subjects) for which complete data were available for inclusion in the meta-analysis, bioidentical estrogen had no clinically significant effect on depressive symptoms (standardized mean difference [SMD] -0.02; confidence interval [95% CI] -0.41 to +0.38). Pooled studies were highly heterogeneous, and numerous approaches to reducing heterogeneity were unsuccessful. Subgroup analyses showed no significant difference in effect for women treated with adjunctive progestogen, women treated with unopposed estrogen, perimenopausal, or postmenopausal and mixed populations. A possible benefit in perimenopausal women treated with unopposed estradiol may have been diluted by studies including older postmenopausal women whose depressive symptoms were unrelated to menopause.
In this first systematic review of bioidentical hormone replacement therapy, we found that bioidentical estrogen has no clear benefit in treating depressive symptoms in menopausal women, but heterogeneity of available studies limits the potential for definitive conclusions. Future research should compare bioidentical estrogen with nonbioidentical estrogen for treatment of depressive symptoms in perimenopausal women.
生物同源雌激素的支持者声称，它们在治疗更年期症状（包括抑郁症状）方面更具优势。一些小型试验研究了生物同源雌激素对抑郁症状的影响，结果相互矛盾。我们进行了一项系统评价，以评估生物同源雌激素治疗围绝经期和绝经后女性抑郁症状的有效性和安全性。
我们检索了科学文献，查找至少为期4周的随机对照试验，这些试验比较了生物同源雌激素与安慰剂对绝经女性抑郁症状的疗效。主要结局指标是通过有效量表评估抑郁症状的改善情况。
我们找到了12项符合纳入标准的临床试验，其中两项数据不足，无法进行定量分析。在可纳入荟萃分析的10项研究（共1208名受试者）中，生物同源雌激素对抑郁症状没有临床显著影响（标准化均数差[SMD] -0.02；置信区间[95%CI] -0.41至+0.38）。汇总研究具有高度异质性，多种降低异质性的方法均未成功。亚组分析显示，接受辅助孕激素治疗的女性、接受单纯雌激素治疗的女性、围绝经期女性、绝经后女性以及混合人群在疗效上没有显著差异。接受单纯雌二醇治疗的围绝经期女性可能存在的益处，可能被纳入了老年绝经后女性的研究稀释，这些老年女性的抑郁症状与绝经无关。
在这项首次对生物同源激素替代疗法进行的系统评价中，我们发现生物同源雌激素在治疗绝经女性抑郁症状方面没有明显益处，但现有研究的异质性限制了得出确定性结论的可能性。未来的研究应比较生物同源雌激素与非生物同源雌激素治疗围绝经期女性抑郁症状的效果。
