The Safety of Oral Versus Transdermal Estrogen

Denise Black, MD, FRCSC


Menopause. 2020;27(11):1328-1329. 

In This Article

Women With Increased Cardiovascular Risk

Traditional cardiovascular risk factors include age, hypertension, smoking, hyperlipidemia, and diabetes. Metabolic syndrome (MetS), a cluster of closely related clinical disorders including obesity, glucose intolerance, insulin resistance, hypertension, and dyslipidemia, is present in increasing numbers of aging women. At least 35% of women aged between 50 and 59 years display this syndrome. The presence of MetS further increases the risk of cardiovascular disease (CVD) in postmenopausal women. Epidemiologic data strongly support a causal role of high triglycerides in the development of atherosclerotic coronary vascular disease.

In women who are overweight with MetS, transdermal estrogens result in greater improvement in parameters of insulin resistance and do not increase triglycerides. They are preferred over oral estrogens in this patient group.[5] Women who smoke are at increased risk of CVD, and transdermal estrogen is preferable to oral estrogen in these women as well.[6]

It is clear that women with increased risk for VTE, stroke, and CVD have a safety benefit when estrogen is administered transdermally as opposed to orally. Estrogen dose and choice of endometrial protective agent may affect safety as well.[7] However, what about the women without these risks?