The role of intranasal estradiol spray in the management of moderate to severe vasomotor symptoms in menopausal women.
Hormone therapy (HT) is the most effective treatment at present available for climacteric symptoms. As harmful effects were highlighted in recent randomized clinical trials, the risk-benefit ratio does not favor the use of HT for prevention of cardiovascular diseases and bone fractures in postmenopausal women. Nevertheless, experimental and clinical trials suggest that adverse effects of HT basically depend on the estrogen and progestin formulation, dosage, route of administration, patient's age, associated diseases, and duration of treatment. All estrogen formulations and routes of administration have comparable beneficial effects on vasomotor and urogenital symptoms and on bone structure. But adverse effects may differ. Thus, cardiovascular and invasive breast cancer risks are higher with oral estrogen than with transdermal estradiol. However, transdermal estradiol is not free of inconveniences such as differences among individuals in absorption rates, loss of patches due to poor adhesion, and skin irritation. HT requires careful adjustment to each individual patient and continuous monitoring of clinical evolution. In the future, this adjustment and maybe the use of alternative routes such as intranasal could benefit from genetic screening to maximize in each individual the ratio between positive and adverse effects of HT.
Castelo-Branco
Camil
C
Hospital Clínic, University of Barcelona, Barcelona, Spain. castelobranco@ub.edu
Coloma
Josep Lluis
JL
D000281:Administration, Intranasal; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy* / Q000473:pathology; D004304:Dosage Forms; D004958:Estradiol / Q000008:administration & dosage* / Q000493:pharmacokinetics; D015914:Estrogen Replacement Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008593:Menopause / Q000187:drug effects / Q000502:physiology; D009330:Nebulizers and Vaporizers; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014666:Vasomotor System / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology
D004304:Dosage Forms; D004958:Estradiol