oa SA Pharmaceutical Journal - Oral versus transdermal hormone therapy at menopause : review
Several options are available to treat moderate to severe vasomotor symptoms in menopausal women, including oestrogen-only and oestrogen-progestogen combination products, to meet the needs of both hysterectomised and non-hysterectomised women, respectively. In addition to selecting an appropriate oestrogen or oestrogen-progestogen combination, consideration should be given to the route of administration to best suit the needs of the individual patient. Delivery systems for menopausal hormone therapy include oral tablets, transdermal patches, transdermal gel and intravaginal preparations. While oral therapy remains the most commonly used route of administration in many countries, evidence suggests that oral delivery may lead to some undesirable physiological effects as a result of significant gut and hepatic first-pass metabolism of oestrogen. Advantages of the transdermal route include the ability to administer oestradiol (the exact molecular form of oestrogen secreted by the premenopausal ovary) directly to the bloodstream using a lower dose than oral oestrogen, and causing minimal stimulation of hepatic protein production. This review article compares the risks and benefits of oral versus transdermal hormone therapy for the treatment of menopausal symptoms.
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