Do different delivery systems of hormone therapy have different effects on psychological symptoms in surgically menopausal women? A randomized controlled trial.
OBJECTIVE
To compare the influence of different delivery forms of estrogen therapy on menopausal and psychological symptoms in surgically menopausal women.


METHODS
Surgically menopausal women were assigned to a 1-year-therapy with oral conjugated estrogen 0.625mg/day (n=35), intranasal 300microg/day estradiol hemihidrate (n=33), percutaneous gel 1.5mg/day estradiol hemihidrate (n=32) or no treatment (control group, n=32). Serum E(2) and FSH levels, Kupperman's Scale used to assess climacteric symptoms, Hamilton Depression Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) scores were assessed before and after 1-year-therapy.


RESULTS
After 1 year, the greatest increase in E(2) was in the oral group, followed by the transdermal gel, and then the intranasal group (oral vs transdermal gel: p=0.022: oral vs intranasal: p=0.0001; transdermal gel vs intranasal: p=0.0001). All treatment groups improved significantly in total Kupperman index score and HARS (p<0.05) with no difference between the groups. With regard to HDRS, all treatment groups improved significantly (p<0.05) with the greatest improvement in the oral group, and no difference between transdermal gel and intranasal groups (oral vs transdermal gel: p=0.015; oral vs intranasal: p=0.001; transdermal gel vs intranasal: p=0.735). Control group scored worse in all tests after study (p<0.05). All scores correlated significantly with post-treatment serum E(2) and FSH levels (p<0.001).


CONCLUSIONS
Oral, intranasal and percutaneous gel estradiol therapies significantly improve menopausal and psychological symptoms in surgically menopausal women with oral route better than transdermal gel and intranasal modalities against depressive mood.
Baksu
Basak
B
Sişli Etfal Training and Research Hospital 3, Gynecology and Obstetrics Clinic, Istanbul, Turkey. basakbaksu@yahoo.com
Baksu
Alparslan
A
Göker
Nimet
N
Citak
S
S
D000279:Administration, Cutaneous; D000281:Administration, Intranasal; D000284:Administration, Oral; D000328:Adult; D001007:Anxiety / Q000188:drug therapy*; D003863:Depression / Q000188:drug therapy*; D004958:Estradiol / Q000008:administration & dosage* / Q000378:metabolism / Q000494:pharmacology; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause / Q000187:drug effects / Q000523:psychology*
D004966:Estrogens, Conjugated (USP); D004958:Estradiol; D005640:Follicle Stimulating Hormone