A comparison of transdermal and oral HRT for menopausal symptom control.

Background: To compare clinical efficacy, side effects and continuation rates using oral hormone therapy (HT), percutaneous gel, and transdermal patch.

Methods: Eighty-eight symptomatic menopausal women were allocated into 3 groups (oral, gel, patch); the patch group was further subdivided to be given either reservoir or matrix patch. After one year of follow up, symptomatic improvement, side effects and continuation rates were assessed and compared. Statistical analysis was performed using multiple analysis of variants and chi-square tests wherever appropriate, with p value < or = 0.05 considered significant.

Results: Percentage of patients showing complete relief from vasomotor symptoms at one year were 62%, 95%, and 100% among oral, gel, and patch groups, respectively. Similarly, above-mentioned percentages were 30%, 65%, and 68% for psychological disturbances; 64%, 100%, and 100% for genital symptoms; 40%, 90%, and 100% for urinary symptoms. Incidence of side effects, such as breakthrough bleeding [6 (60%), 6 (71%), and 5 (66%) among oral, gel, and patch groups at 6 months] and mastodynia [5 (14%), 6 (20%), and 5 (18%)] was comparable among three groups. Skin intolerance was significantly higher (92% of patients) in the reservoir patch group compared to the matrix patch (22% of patients) and gel (10% of patients) at first month. Continuation rate for one year was comparable among oral, gel, and matrix patch: 81%, 83%, and 88%, respectively. However, continuation rate was 50% among reservoir patch group.

Conclusion: Transdermal HT performed significantly better than oral HT in menopausal symptom control. Reservoir patch was unsuitable in tropical climate where matrix patch and gel performed better.