Safety and efficacy of transdermal estradiol replacement therapy in postmenopausal liver transplanted women : a preliminary report

To determine the safety and efficacy of transdermal estrogen replacement therapy in liver transplanted menopausal women. Thirty-two menopausal women who had at least 6 months earlier undergone liver transplantation, ages from 46-70 years old receiving hormone replacement therapy. The study was an open prospective. The subjects received transdermal estradiol replacement therapy in combination with progestin (EstracombR-Ciba, 50 microg/24 h, 250 microg/24 h) if the uterus was intact, and estradiol alone (EstradermR-Ciba, 50 microg) if the uterus had been removed. The follow-up time was 6 months. Liver function parameters and hemostatic parameters were measured at 0, 3 and 6 months. Gynecological transvaginal ultrasound (TVS) was performed at 0 and 6 months. The efficacy of the hormonal treatment was assessed by measuring serum concentrations of estradiol, estrone, FSH, LH and SHBG, by measuring endometrial thickness with TVS and by recording changes in subjective climacteric symptoms at 0 and 6 months. Safety was assessed by measuring liver enzyme activity, liver synthesis functions and coagulation factors. Estrogen replacement therapy did not impair any of the liver parameters measured and no thrombotic effect could be detected. Hormonal effects of the regimen prescribed could be verified both biochemically, clinically and by TVS. A clinically desired hormonal effect was achieved by the dose of 50 microg estradiol-17beta. Liver function and hemostatic balance were unaffected by the transdermal hormonal treatment. Immunosuppressive drugs and transdermal estrogen may well be combined.