Safety of menopause hormone therapy in postmenopausal women at higher risk of venous thromboembolism: a systematic review.

IF 3.2 4区医学 Q1 OBSTETRICS & GYNECOLOGY

Climacteric Pub Date : 2025-06-09 DOI:10.1080/13697137.2025.2503874

Amy Hicks, Danielle Robson, Bianca Tellis, Sally Smith, Scott Dunkley, Rodney Baber

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引用次数: 0

Abstract

Objective: Studies have shown that oral estrogen with or without progestogen increases the risk of venous thromboembolism (VTE). Recent data suggest that transdermal estrogen confers little to no increased risk of VTE. There is no systematic review that examines menopause hormone therapy (MHT) use in women with risk factors for VTE. This systematic review therefore aims to summarize the evidence in this population.

Method: The OVID Medline, Embase, PubMed and CENTRAL online databases were searched. A total of 762 studies were screened and 10 were included in the study.

Results: Six studies were case-control studies, two were randomized controlled trials (RCTs), one was an RCT that contained a nested case-control study and one was a cohort study. Studies were heterogeneous in their definition of menopause, dose, form and route of administration of MHT, and the underlying VTE risk factor being assessed. In women with risk factors for VTE, transdermal estrogen conferred no increased risk of VTE. Oral estrogen alone has the next safest profile, and oral estrogen plus a progestogen conferred the highest increased risk of VTE.

Conclusion: Transdermal MHT appears safe in women with risk factors for VTE. Oral MHT, notably oral estrogen plus a synthetic progestogen, does increase relative risk. More contemporary data are required to confirm these findings.

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绝经后静脉血栓栓塞高风险妇女绝经激素治疗的安全性：一项系统综述。

目的：研究表明口服雌激素加或不加孕激素会增加静脉血栓栓塞（VTE）的风险。最近的数据表明，经皮雌激素几乎没有增加静脉血栓栓塞的风险。目前还没有关于绝经期激素治疗（MHT）在有静脉血栓栓塞危险因素的女性中的应用的系统综述。因此，本系统综述旨在总结这一人群的证据。方法：检索OVID Medline、Embase、PubMed、CENTRAL在线数据库。共筛选了762项研究，其中10项纳入了本研究。结果：6项研究为病例对照研究，2项为随机对照试验（RCT）， 1项为包含嵌套病例对照研究的随机对照试验，1项为队列研究。研究在更年期的定义、MHT的剂量、形式和给药途径以及评估潜在的静脉血栓栓塞危险因素方面存在差异。在有静脉血栓栓塞危险因素的女性中，经皮雌激素不会增加静脉血栓栓塞的风险。单独口服雌激素的安全性次之，口服雌激素加孕激素增加静脉血栓栓塞的风险最高。结论：经皮MHT对有静脉血栓栓塞危险因素的女性是安全的。口服MHT，特别是口服雌激素加合成孕激素，确实会增加相对风险。需要更多的当代数据来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Climacteric 医学-妇产科学

CiteScore

1.70

自引率

7.10%

发文量

审稿时长

1 months

期刊介绍： Climacteric is the official journal of the International Menopause Society (IMS). As an international peer-reviewed journal it publishes original research and reviews of all aspects of aging in women. Climacteric was founded by the IMS in 1998 and today has become a leading journal in the publication of peer-reviewed papers on the menopause, climacteric and mid-life health. Topics covered include endocrine changes, symptoms attributed to the menopause and their treatment, hormone replacement and alternative therapies, lifestyles, and the counselling and education of peri- and postmenopausal women. Climacteric, published bimonthly, also features regular invited reviews, editorials and commentaries on recent developments. The editorial review board of Climacteric includes leading scientific and clinical experts in the field of midlife medicine and research and is headed by its Editor-in-Chief, Professor Rod Baber of Australia. He and his team of Associate Editors act independently to set a clear editorial policy, co-ordinate peer review, and ensure a rapid response to submitted papers.