Johns Hopkins Bayview Medical Center, Baltimore, MD.
Johns Hopkins University, Baltimore, MD.
Menopause. 2022 Jan 14;29(4):483-490. doi: 10.1097/GME.0000000000001938.
It is estimated that over 45% of women in the United States are menopausal. Many of these women suffer from vasomotor symptoms of menopause, for which the gold standard treatment is menopause hormone therapy (MHT). However, MHT use has been controversial since the Women's Health Initiative (WHI) study in 2001. Transdermal MHT has been shown to be effective for treatment of vasomotor symptoms and does not increase the risk of venous thromboembolism (VTE) when used in healthy postmenopausal women. However, there is little data on its safety in women at increased risk for VTE such as women with prior VTE, increased body mass index, thrombophilia, tobacco use, autoimmune disease, chronic inflammatory disorders, recent surgery, trauma, or immobilization. This scoping review of the literature provides clinicians with an overview of the evidence on the risk profile of transdermal MHT use in these postmenopausal women at increased risk of VTE.
We searched all published studies from 2000 to 2020 and included 13 primary articles on transdermal MHT use in postmenopausal women at increased risk of VTE.
In women with prior VTE, two studies found a decrease in coagulability and no increased risk of recurrent VTE with transdermal MHT use. In women with increased body mass index, three studies found no increased VTE risk in transdermal MHT users. In women with prothrombotic genetic polymorphisms, three studies found minimal to no increased VTE risk in transdermal MHT users. In women with various proinflammatory comorbidities, five studies found an improved thrombotic profile and no increased VTE risk with transdermal MHT use. This scoping review provides data regarding the safety of transdermal MHT use in postmenopausal women with risk factors for VTE, and clinicians should have risk versus benefit discussions with each patient regarding its use.
据估计，美国超过 45%的女性处于绝经期。这些女性中有许多患有绝经相关的血管舒缩症状，其金标准治疗方法是绝经激素治疗（MHT）。然而，自 2001 年妇女健康倡议（WHI）研究以来，MHT 的使用一直存在争议。透皮 MHT 已被证明对治疗血管舒缩症状有效，并且在健康绝经后妇女中使用不会增加静脉血栓栓塞（VTE）的风险。然而，关于其在 VTE 风险增加的女性（如既往 VTE、体重指数增加、血栓形成倾向、吸烟、自身免疫性疾病、慢性炎症性疾病、近期手术、创伤或固定）中的安全性数据很少。本文献范围综述为临床医生提供了有关 VTE 风险增加的绝经后妇女使用透皮 MHT 的风险概况的证据概述。
我们搜索了 2000 年至 2020 年发表的所有研究，并纳入了 13 篇关于 VTE 风险增加的绝经后妇女使用透皮 MHT 的原始文章。
在既往有 VTE 的女性中，两项研究发现使用透皮 MHT 可降低凝血性，且无复发性 VTE 的风险增加。在体重指数增加的女性中，三项研究发现使用透皮 MHT 无 VTE 风险增加。在存在促血栓形成遗传多态性的女性中，三项研究发现使用透皮 MHT 的女性 VTE 风险最小或没有增加。在存在各种促炎合并症的女性中，五项研究发现使用透皮 MHT 可改善血栓形成特征，且无 VTE 风险增加。本范围综述提供了有关 VTE 风险因素的绝经后妇女使用透皮 MHT 的安全性数据，临床医生应与每位患者就其使用进行风险与获益讨论。
