Using r and om-effects models , estrogen replacement therapy showed an increase in bone mineral density [ weighted mean change from baseline 0.09 g/cm2 ( 0.04–0.14 ) ] that differed by type of estrogen but not route of administration .
Oral estrogen replacement therapy showed a higher increase in high density lipoprotein cholesterol levels when compared to transdermal [ weighted mean difference 9.33 mg/dl ( 4.82–13.85 ) ] with no significant effect on other lipid fractions .
The current evidence suggests possible benefit of estrogen replacement therapy  on bone mineral density and high density lipoprotein cholesterol .
Patients with Turner syndrome have adverse bone and cardiovascular outcomes from chronic estrogen deficiency .
Hence , long-term estrogen replacement therapy is the cornerstone treatment .
The estimates of its effect and optimal use , however , remain uncertain .
We aim ed to summarize the benefits and harms of estrogen replacement therapy on bone , cardiovascular , vasomotor and quality of life outcomes in patients with Turner syndrome .
A randomized trial of transdermal and oral estrogen therapy in adolescent girls with hypogonadism
Background Adolescent females with ovarian failure require estrogen therapy for induction of puberty and other important physiologic effects . Currently , health care providers have varying practice s without evidence -based st and ards , thus investigating potential differences between oral and transdermal preparations is essential . The purpose of this study was to compare the differential effects of treatment with oral conjugated equine estrogen ( OCEE ) , oral 17β estradiol ( OBE ) , or transdermal 17β estradiol ( TBE ) on biochemical profiles and feminization in girls with ovarian failure . Study design 20 prepubertal adolescent females with ovarian failure , ages 12–18 years , were r and omized to OCEE ( n = 8) , OBE ( n = 7 ) , or TBE ( n = 5 ) for 24 months .  Estrogen replacement was initiated at a low dose ( 0.15 mg OCEE , 0.25 mg OBE , or 0.0125 mg TBE ) and doubled every 6 months to a maximum dose of 0.625 mg/d OCEE , 1 mg/d OBE , or 0.05 mg/d TBE . At 18 months , micronized progesterone was added to induce menstrual cycles . Biochemical markers including sex hormones , inflammatory markers , liver enzymes , coagulation factors , and lipids were obtained at baseline and 6 month intervals . Differences in levels of treatment parameters between the groups were evaluated with one-way analysis of variance ( ANOVA ) . The effect of progesterone on biochemical markers was evaluated with the paired t-test . Results Mean ( ±SE ) estradiol levels at maximum estrogen dose ( 18 months ) were higher in the TBE group ( 53 ± 19 pg/mL ) compared to OCEE ( 14 ± 5 pg/mL ) and OBE ( 12 ± 5 pg/mL ) ( p ≤ 0.01 ) . The TBE and OBE groups had more effective feminization ( 100 % Tanner 3 breast stage at 18 months ) . There were no statistical differences in other biochemical markers between treatment groups at 18 months or after the introduction of progesterone . Conclusions Treatment with transdermal 17β estradiol result ed in higher estradiol levels and more effective feminization compared to oral conjugated equine estrogen but did not result in an otherwise different biochemical profile in this limited number of heterogeneous patients . OBE and TBE provide safe and effective alternatives to OCEE to induce puberty in girls , but larger prospect i ve r and omized trials are required . Trial registration Clinical Trials Identifier : NCT01023178
Using r and om-effects models , estrogen replacement therapy showed an increase in bone mineral density [ weighted mean change from baseline 0.09 g/cm2 ( 0.04–0.14 ) ] that differed by type of estrogen but not route of administration .
Oral estrogen replacement therapy showed a higher increase in high density lipoprotein cholesterol levels when compared to transdermal [ weighted mean difference 9.33 mg/dl ( 4.82–13.85 ) ] with no significant effect on other lipid fractions .
The current evidence suggests possible benefit of estrogen replacement therapy  on bone mineral density and high density lipoprotein cholesterol .
Patients with Turner syndrome have adverse bone and cardiovascular outcomes from chronic estrogen deficiency .
Hence , long-term estrogen replacement therapy is the cornerstone treatment .
The estimates of its effect and optimal use , however , remain uncertain .
We aim ed to summarize the benefits and harms of estrogen replacement therapy on bone , cardiovascular , vasomotor and quality of life outcomes in patients with Turner syndrome .