Meta-analysis Of Menopausal Hormone Therapy In The Management Of Menopause

Objective: To systematically evaluate the effect of menopausal hormone therapy(MHT)and window period of MHT on symptom management of menopausal women.Methods: Systematic search through computer has been published in English databases such as Pubmed,The Cochrane Library,Embase and Chinese databases such as Wang Fang,CNKI and CQVIP since the establishment of the database to February 2021.All MHT-related symptoms in peri-menopausal women were collected in a randomized controlled trial.The language of retrieval literature is limited to Chinese and English.According to the literature selection criteria,two literature commentators selected the retrieved literature,evaluated the literature quality and extracted the data.The meta-analysis of the collected data was carried out by using revman5.3analysis software.Results: A total of 33 articles were included in the analysis,all of which were randomized controlled trials.The results of meta-analysis showed that hormone therapy had higher vaginal cell maturity index(SMD=0.99)and lower vaginal PH(SMD=-0.97)than placebo,and there were significant differences between the two groups(P<0.00001).The BMD of all measured sites increased significantly(neck of femur P=0.0002;trochanter of trochanter P=0.002;total hip P<0.00001;lumbar vertebrae P<0.00001),and the increase of total hip and lumbar vertebrae(SMD=1.02%/1.36%)was slightly higher than that of femoral neck and trochanter(SMD=0.74%/0.78%).Increased high density lipoprotein(SMD=0.36,P=0.0007).Low density lipoprotein and total cholesterol decreased(SMD=-0.46/-0.36,P=0.0002/0.004).According to different administration routes,it was found that oral administration of hormone therapy was beneficial to the increase of high density lipoprotein(P=0.0005)and the decrease of low density lipoprotein(P<0.00001)and total cholesterol(P=0.0002),but there was no significant difference between transdermal and vaginal administration(P>0.05).According to the subgroup analysis of blood pressure according to the time of menopause for 10 years or the average age of 60 years old,the blood pressure of early menopausal women treated with corticosteroid decreased slightly(systolic blood pressure and diastolic blood pressure SMD=-0.18/-0.42,P=0.26/0.009),and that of late menopausal women treated with hormone increased slightly(systolic blood pressure and diastolic blood pressure SMD=0.06/0.02,P=0.0003/0.19respectively).Women’s body mass index decreased slightly(SMD=-0.01),weight gain was not significant(SMD=0.03),muscle mass increased(SMD=0.39)and abdominal fat decreased(SMD=-0.29),but there was no significant difference(P>0.05).The level of estrogen increased(P<0.00001),while the level of follicle-stimulating hormone decreased(P<0.0005).Kupperman score decreased(SMD=-2.05,P<0.00001).Conclusions: This meta-analysis shows that compared with placebo,MHT has beneficial effects on improving vaginal maturity,vaginal PH,bone mineral density and blood lipids.And in the improvement of blood lipids,oral administration is better than transdermal and vaginal administration.It had a neutral effect on body weight,body mass index,muscle mass and abdominal fat.At the same time,early use of MHT in postmenopausal women can reduce cardiovascular risk.