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Grand Rounds

Does Hormone Therapy in Menopause Impact Mortality?

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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

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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

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