While there have been concerns regarding the risks associated with prolonged use of hormone replacement, an increasing number of studies suggest that the risk may be relatively low in certain populations and that hormone replacement is appropriate in certain settings. A recent study published in JAMA has focused on mortality rates in women treated with hormone replacement. JoAnn Manson, MD, the lead author of study, notes that all-cause mortality is an important endpoint to examine.
With an intervention such as hormone therapy, with a complex pattern of benefits and risk, all-cause mortality provides a critically important summary measure, showing the net effect of the intervention on serious and life-threatening health outcomes. Hormone therapy has known benefits, including a reduction in symptoms and in hip fracture and other fractures. Hormone therapy has also been linked to risks such as venous thromboembolism, stroke, and, with estrogen plus progestin, increased risk for breast cancer.
In this study including over 27,000 postmenopausal women, hormone therapy with conjugated equine estrogen (CEE) plus medroxyprogesterone acetate (MPA) for a median of 5.6 years or with CEE alone for a median of 7.2 years was not associated with increased risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years. Furthermore, these findings did not support the use of hormone therapy for the prevention of cardiovascular disease, other chronic diseases, or to reduce mortality,
This study is consistent with a previous meta-analysis carried out several years ago which included data from 43 randomized clinical trials.
Ruta Nonacs, MD PhD
Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women’s Health Initiative randomized trials. JAMA. 2017;318:927-938.
Menopausal Hormone Therapy: Why Mortality Outcomes Are ‘Vital’ (Medscape – free subscription)
Hormone Therapy: No Excess Mortality in 18-Year WHI Follow-up (Medscape – free subscription)
NAMS’ New Hormone Therapy Position Statement: Clinical Takeaways (Medscape – free subscription)