BACKGROUND AND PURPOSE:

• Most studies that have assessed overall mortality and use of hormone therapy (HT) have not noted a significant association
  • While studies such as WHI are high quality, there are still limitations including testing only a single regimen and patient demographic (older women)
• Holm et al. (BJOG, 2018) sought to determine long-term patterns of mortality following different modalities of HT for menopausal women

METHODS:

• Population-based prospective cohort study
  • Women age 50-64
  • Without previous cancer diagnosis
  • Participant followed from baseline (first study visit) until death, emigration from Denmark or end of 2013
• Women filled out validated questionnaires
  • Anthropometric measurements and laboratory specimens obtained by professional staff
• Exposure
  • HT (never/previous/current use) and, if relevant, the age at which they started HT
  • Further information included type of HT, duration of use and route of administration
• Main outcomes
  • All-cause and cause-specific mortality
• Results adjusted for covariates such as
  • Alcohol | Smoking | Physical activity | BMI | Education level

RESULTS:

• 29,243 women were included
  • 17.6 years average follow up
  • Median age of 56 years
• Hormone use had no impact on all‐cause mortality, regardless of modality, route or duration after adjusting for relevant lifestyle risk factors
• Among HT users
  • Lower cardiovascular disease mortality after 5 years follow up
    • Hazard ratio (HR) 0.54; 95% CI, 0.32–0.92
    • Benefit disappeared with additional follow up
  • Lower colorectal cancer mortality among current HT users vs never users
    • HR 0.64; 95% CI, 0.46–0.89
    • Protective effect was significant in previous users as well estrogen only route
    • Only evident after 15 years follow up
  • Higher breast cancer mortality in current vs never users
    • HR 1.34; 95% CI, 1.05–1.72 after 15 years
    • Higher risk for combined continuous HT (HR 1.56) was significant as was oral route
    • Estrogen only also had a higher HR (1.37) but as not statistically significant
    • Only evident after 15 years follow up

CONCLUSION:

• Hormone use in menopause was not associated with mortality in keeping with WHI results (see ‘Related ObG Topics’ below)
• There were significant cause-specific mortality effects stressing the importance of patient specific considerations

Learn More – Primary Sources:

Pattern of mortality after menopausal hormone therapy: long‐term follow up in a population‐based cohort

Related ObG Topics:

North American Menopause Society: Hormone Therapy Statement

The WHI Randomized Trials: Is Menopausal Hormone Therapy Associated with Long-Term Mortality?

Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations