Speakers - 2026

Title: Comparative effects of oral versus transdermal menopausal hormone therapy on key lipid parameters: A scoping review

Abstract

Background Menopausal Hormone Therapy (MHT) is commonly used as an approach to alleviate vasomotor symptoms in both peri- and post-menopausal women. While MHT is known to have an influence on lipid profile, it remains unclear how lipid effects vary by route of administration – specifically between oral and transdermal therapy.

Objectives This scoping review aimed to map and synthesise the current evidence comparing the effects of oral and transdermal MHT on key lipid parameters in peri- and post-menopausal women.

Methods This review followed the PRISMA-ScR guidelines. A comprehensive search using three databases – MEDLINE, EMBASE and APA PsycINFO was conducted, limited to papers published in the last 10 years. Studies were included if they reported lipid outcomes following oral and transdermal MHT use in peri- or post-menopausal women (and outcomes stratified by route). Title, abstract, full-text screening and data charting were performed by 2 independent reviewers. Data was extracted from eligible studies independently, and charted by study characteristics, MHT route, follow-up duration and lipid outcomes.

Results After screening 2,493 studies, a total of 6 studies met the criteria and were therefore included in this review. Studies were conducted across a wide geographical range, and there was large heterogeneity in study design, population characteristics and outcomes reported. Across included studies, oral therapy was more frequently associated with consistent lipid outcomes, whereas with transdermal therapy, findings were more variable.

Conclusion Current evidence suggests that there is greater consistency in lipid profile effects with oral compared to transdermal MHT, however this is limited by heterogeneity and limited comparative data. This field lacks research on long-term effects on MHT, and effects across a broader age range This review highlights the need for more controlled head-to-head trials comparing the effects of oral and transdermal MHT on lipid profile.

Take home messages:

1. Current evidence suggests that oral MHT is associated with more consistent effects on lipid profile than transdermal MHT, although comparative data limits this conclusion.
2. Across included studies, both oral and transdermal therapy LDL-C were generally associated with:  ↓ ,Total cholesterol ↓ , HDL-C↑ , and triglycerides tended to ↑ with oral therapy and a ↓ with transdermal therapy.
3. There is vast heterogeneity in how lipid outcomes are reported, limiting comparison between routes.
4.  There is a need for high-quality, controlled head-to-head trials comparing the two routes administration, especially for longer follow-up durations.

This research may aid clinicians to have evidence-based discussions with peri- and post-menopausal patients; especially when cardiovascular risk factors are present. It supports counselling around MHT beyond symptoms control and highlights where uncertainty remains. This review can inform future comparative trials and highlight gaps in the research.