VTE Risk in Postmenopausal Women Receiving Oral and Non-Oral Hormone Therapy Systematic Review and Meta-Analysis

Hormone replacement therapy can improve the quality of life for women with hypo-oestrogenic symptoms. Many women are still prescribed oestrogen therapy to treat postmenopausal symptoms. Venous thromboembolism (VTE), either deep vein thrombosis or pulmonary embolism, is a main harmful effect of HT among postmenopausal women. We aim to evaluate the risk of VTE in postmenopausal women using hormonal therapy either oral or non-oral types. Systematic review of MEDLINE, Cochrane CENTRAL, EMBASE, and Clinical Trials.gov according to PRISMA guidelines. 22 studies were included in the metaanalyses (9 case-control studies, 9 cohort studies, and 4 randomized controlled trials). VTE risk was not increased with non-oral HT, including users of estrogens and estrogens plus progestins (OR 0.97 [0.9–1.06]), non-oral estrogen therapy (ET)-only (OR 0.95 [0.81–1.10]), and non-oral combined estrogen-progestin therapy (OR 0.92 [0.77–1.09]). The comparison of non-oral vs. oral HT showed increased VTE risk with oral HT (OR 1.66 [1.39–1.98]). Increase the risk of VTE in postmenopausal women who using oral HT versus non oral HT.