This article draws on recent research and consensus statements to evaluate the adoption of transdermal oestrogen and micronised progesterone in South Africa, in comparison with traditional oral oestrogen preparations. 

In the evolving landscape of menopausal hormone therapy (MHT), significant strides have been made in understanding the nuanced roles of oestrogen and progesterone.  

This article draws on recent research and consensus statements to evaluate the adoption of transdermal oestrogen and micronised progesterone in South Africa, in comparison with traditional oral oestrogen preparations.   

Oestrogen-alone therapy: A re-evaluation   

Historically, the use of oestrogen-alone therapy has been contentious, primarily due to concerns about breast cancer risk. However, a landmark meta-analysis by Chlenowski Manson et al. (2024) revisits this issue. Findings from 10 randomised trials (The WHI being the largest) and 14 282 participants included are showing that oestrogen-alone therapy significantly reduces the risk of breast cancer by 23% and mortality by 40% over a median follow-up of 20.3 years. These findings challenge earlier cohort studies that suggested an increased risk, highlighting the importance of context in evaluating MHT outcomes (Chlenowski Manson et al., 2024).   

The shift to safer alternatives   

In line with global trends and the latest guidelines from the British Menopause Society (2020), there is a strong recommendation for the use of transdermal oestrogen and micronised progesterone. Transdermal oestrogen is associated with a lower risk of venous thrombosis and stroke compared to its oral counterpart, making it a preferable option for women with risk factors such as CVD, diabetes, or obesity. Micronised progesterone, on the other hand, offers a safer profile regarding breast cancer risk. The systematic review by the International Journal of Gynecology & Obstetrics (2018) indicates that micronised progesterone does not elevate breast cancer risk within the first five years of treatment, a crucial consideration for long-term therapy planning.   

Barriers to adoption in South Africa   

Despite the compelling evidence supporting these safer MHT options, their uptake in South Africa remains limited. Factors such as entrenched prescribing habits, patient perceptions that equate treatment efficacy with oral medication, and assumptions about the high cost of transdermal options persist. Addressing these barriers through education and awareness is critical.   

Clinical recommendations   

Individualised care: Tailor hormone therapy based on individual risk factors and preferences, considering the broader benefits of symptom control and potential reductions in long-term health risks.  

Education and dialogue: Engage in open discussions with patients about the advantages of transdermal and micronised options, debunking myths related to their efficacy and cost.   

Ongoing monitoring: Implement regular follow-ups to assess the effectiveness of the prescribed therapy and make adjustments as needed.   

Conclusion   

For South African healthcare providers, embracing transdermal oestrogen and micronised progesterone represents a forward-thinking approach to menopausal care. By aligning with global best practices and research, we can enhance the quality of life for menopausal women while mitigating long-term health risks.   

References available on request.