Birkhäuser M H, Haenggi W
Department of Obstetrics & Gynecology, University of Berne, Switzerland.
Int J Fertil Menopausal Stud. 1994;39 Suppl 1:11-9.
The benefits of hormone replacement therapy (HRT) are well established for the different systemic administration routes used today. Relief from somatic and vasomotor postmenopausal symptoms can be obtained by all recognized forms of HRT. The prophylactic action of peroral and percutaneous administration of HRT on postmenopausal bone loss is identical if the appropriate protective dosage of the estrogen component is chosen for each galenic form. The second metabolic benefit of HRT, the cardioprotective effect of ERT, is well accepted for the peroral route. New data on the direct effect of estradiol on the arterial wall as well as recent serum lipid results obtained during percutaneous administration of estradiol in postmenopausal women allow the conclusion that the percutaneous route induces cardioprotection similar to that obtained with the classical peroral route. This opinion is supported by animal data. Furthermore, observations in animals suggest that the benefits of ERT are not neutralized by either sequential or fixed addition of progestin to the estrogen. Except in some rare cases with a particular indication for either the peroral or the percutaneous administration of HRT, the choice of route of administration should be made on the basis of maximum acceptability by the patient.
激素替代疗法（HRT）对于如今使用的不同全身给药途径而言，其益处已得到充分证实。所有公认的HRT形式均可缓解躯体和血管舒缩性绝经后症状。如果为每种剂型选择合适的雌激素成分保护剂量，口服和经皮给药的HRT对绝经后骨质流失的预防作用是相同的。HRT的第二个代谢益处，即雌激素替代疗法（ERT）的心脏保护作用，口服途径已得到广泛认可。关于雌二醇对动脉壁的直接作用的新数据，以及绝经后妇女经皮给予雌二醇期间获得的近期血脂结果表明，经皮途径诱导的心脏保护作用与经典口服途径相似。这一观点得到了动物数据的支持。此外，动物观察表明，在雌激素中序贯或固定添加孕激素并不会抵消ERT的益处。除了某些极少数有特定指征需口服或经皮给予HRT的情况外，给药途径的选择应基于患者的最大可接受性。
