Hormone Replacement Therapy On Vaginal Microecology In Perimenopausal And Postmenopausal Women:A Meta-Analysis

Objective:To further clarify the relationship between hormone replacement therapy and vaginal microbiota by systematically evaluating the effects of hormone replacement therapy on vaginal microecology using an evidence-based medicine approach,and to provide a theoretical basis for clinical treatment.Research methods:The literature search of Chinese and English databases was completed according to the established search strategy,and all randomized controlled trials on the effect of hormone replacement therapy on the vaginal microbiome of perimenopausal and postmenopausal women were collected,and the language requirements of the retrieved literature were Chinese or English,and the time limit was before December31,2022.Two literature analysts screened the retrieved articles,extracted data,and assessed the quality of the included studies according to study type,randomization method,allocation concealment,blinding,and publication bias.Statistical analysis was performed using Revman 5.4 software,appropriate effect models were selected based on heterogeneity test results,extracted data were statistically analysed,and funnel plots were used to investigate publication bias in included articles.Study results:The meta-analysis finally included 8 articles,including a total of 886 cases(379in the hormone replacement therapy group and 507 cases in the control group),and the results of the meta-analysis showed that:(1)For perimenopausal and postmenopausal women,oral administration of hormone supplementation therapy(RR= 2.32,CI = [1.81,2.97])and vaginal administration(RR=1.92,CI=[1.56,2.35])could significantly improve the quality of vaginal microbiota,and the difference was statistically significant(P <0.05).(2)For perimenopausal and postmenopausal women,the incidence of abnormal vaginal flora in the hormone replacement group was lower than that in the placebo group(RR =0.35,CI = [0.26,0.49]),and the difference between the two groups was statistically significant(P<0.05).(3)For perimenopausal and postmenopausal women,the incidence of bacterial vaginosis in the hormone replacement therapy group was lower than that in the placebo group(RR=0.67,CI=[0.49,0.92]),and the difference between the two groups was statistically significant(P<0.05).(4)For perimenopausal and postmenopausal women,the incidence of vulvovaginal filaridiosis in the hormone replacement treatment group was lower than that in the placebo group(RR=0.22,CI=[0.09,0.58]),and the difference between the two groups was statistically significant(P<0.05).Conclusion:1.Hormone replacement therapy can significantly improve the quality of vaginal flora in perimenopausal and postmenopausal women,and the effect of oral administration is more effective than that of vaginal administration.2.For perimenopausal and postmenopausal women,hormone replacement therapy can significantly reduce incidence rate of bacterial vaginosis.3.For perimenopausal and postmenopausal women,hormone replacement therapy can significantly reduce the incidence rate of vulvovaginal candidiasis.