Effects Of Transdermal HRT To Lipid Level And Homo-cysteine And Effect Of Hrt To Uterine Fibroids: A Systemic Review

Background HRT is the most effective treatment available for reliefof the menopausal symptoms. However, there are still some controversies inclinic, such as the influence of HRT to CVD. There are some advantages oftransdermal HRT. Whether transdermal HRT has different effects versus oralHRT or control may impact the incidence of CVD and application oftransdermal HRT. In addition, uterine fibroid is a common benign tumor ingynecology. A clinical dilemma is whether or not to use HRT inperi-menopausal women with uterine fibroids.Objects To apply HRT in clinic safe and effectively, we carry on thesystem evaluation on effects on blood lipid and HCY by transdermal HRTversus oral HRT or control and effects of HRT on fibroids.Methods Studies searched from databases were included in thissystem review if they were randomized controlled trials (RCTs) about effectson blood lipid and HCY of transdermal HRT versus oral HRT or control oreffects on uterine fibroids of HRT. Studies screening, information exactionand quality assessment of included studies were conducted by method recommended by Cochrane Collaboration.Results (1)22RCTs were included about effects on blood lipid andHCY of transdermal HRT versus oral HRT or control. Results of metaanalysis are:○1The serum levels of TC and HCY decreased significantly intransdermal HRT than control(respectively[MD=0.29,95%CI(0.03,0.55),P=0.03],[MD=0.71,95%(0.10,1.32), P=0.02]).There is no significantchange in HDL-C[MD=-0.03，95%CI(-0.13，0.06)， P=0.51] andTG[MD=0.05,95%CI（-0.16,0.26）,P=0.65] level between transdermal HRTgroup and control group. The serum levels of LDL-C decreased significantlywith transdermal HRT in estrogen only subgroup[MD=0.31，95%CI(0.13，0.48),P=0.0008].○2The changes of serum levels of TC, LDL-C, TG andHCY were all not significant between transdermal and oralHRT(respectively [MD=0.03,95%CI（-0.14,0.20）,P=0.73],[MD=-0.04,95%CI[-0.13,0.04], P=0.27],[MD=0.05,95%CI （-0.16,0.26）,P=0.65],[MD=0.32，95%CI（-0.47，1.11），P=0.42]). In estrogen only subgroup, theserum levels of HDL-C significantly decreased with transdermal HRT thanoral HRT.(2)11studies were included about effects on HRT to uterine fibroids. In4studies about HRT versus control, one reported size of uterine fibroidsincreased significantly in oral HRT group, and another study showed theincidence of amenorrhea and the number and severity of abnormal uterinebleeding episodes was significantly (P<0.05) higher. Two studies reported fibroids size did not change significantly in oral HRT group and tibolonegroup. There were2studies about tibolone versus oral estrogen therapyreports fibroids size did not change significantly in both two groups. TwoRCTs about tibolone versus transdermal HRT reported size of fibroidsincreased statistically in transdermal HRT group in one while in the otherstudy showed no significant differences of fibroids size between the twogroups. Fibroids size increased statistically (p<0.01) in transdermal HRTgroup versus oral HRT group was reported in two studies. One show nosignificant differences of fibroids size between the two different doses ofprogesterone groups.Conclusion The changes of the serum levels of lipid and HCY weresimilar between transdermal and oral HRT. However, versus control grouptransdermal HRT may have benefit effect on lipid and HCY level. Forpostmenopausal women with uterine fibroids transdermal HRT may increasefibroids size and abnormal uterine bleeding. Tibolone did not show thisnegative effect and may be a better choice.