The Effect of Transdermal Estrogen Patch Use on Cardiovascular Outcomes: A Systematic Review.

BACKGROUND: Vasomotor symptoms are the most commonly reported menopausal symptoms. Hormone therapy has been widely used to relieve postmenopausal symptoms. With studies suggesting an increased risk of cardiovascular events and breast cancer with oral hormone therapy use, there has been reluctance to use it. The transdermal estrogen patch provides relief from menopausal symptoms. However, there are limited data on mortality and cardiovascular outcomes, while on the transdermal estrogen patch. METHODS: An extensive search in Cochrane and PubMed databases was conducted up to February 2016. The selection criteria included healthy, peri-, and postmenopausal women between the ages of 50 and 79 and should have received transdermal estrogen therapy. The relationship between estrogen patch use and cardiovascular outcomes was analyzed. Six articles met the criteria and were included. RESULTS: We found some evidence suggestive of protective cardiovascular effects with transdermal estrogen therapy with a decrease in the risk of stroke and no increase in the risk of coronary heart disease, death, or myocardial infarction. DISCUSSION: This is one of the first systematic reviews addressing the association of transdermal estrogen patch use on cardiovascular outcomes. We found some evidence suggestive of a possible protective cardiovascular effect with transdermal estrogen therapy. Further randomized controlled studies are needed with a longer duration of follow-up, to study the cardiovascular effects of transdermal estrogen patches.