RHL Commentary by Lakshmi Seshadri
EVIDENCE SUMMARY
This review focuses on the risks and benefits of long-term use of hormone therapy (HT); excluding short outcomes such as menopausal symptoms (e.g. hot flushes). Fifteen randomized-controlled trials involving 35 089 women aged 41–91 years were included. The review compared a placebo with HT with all estrogens (with or without progestogens) administered via oral, transdermal, subcutaneous or intranasal routes.
The reviewers found no increase in mortality from any cause from any form of HT. However, combined (estrogen plus progestogen) HT was associated with an increase in: venous thromboembolism and coronary events after one year of use; stroke after three years of use; and, gall bladder disease and breast cancer after five years of use.
Similarly, HT with estrogens alone caused an increase in the incidence of stroke and gall bladder disease in healthy postmenopausal older women. On the other hand, statistically significant reductions in the incidence of fractures and colon cancer were found in users of all types of HT.
The number of women in the trials varied widely, the largest number being in the Women's Health Initiative (WHI) trial and the second largest, the Heart and Estrogen/progestin Replacement Study (HERS) trial. The WHI had an overwhelming number of 16 608 women and therefore, the results of the review are largely determined by the results of this trial. As pointed out by reviewers, 11 of the 15 trials included women with a mean age of 55 years, three trials did not provide the mean age and one included women with a mean age of 48 years. Therefore, though the review is on the use of HT in perimenopausal and postmenopausal women, the results are largely applicable to postmenopausal women only. The only subgroup analysis conducted in the review involving women between 50 and 59 years found an increase in risk of venous thromboembolism, with the absolute risk being very small and higher in high-risk women.
A definite conclusion that can be drawn from the review is that HT is not indicated for the treatment of chronic diseases in older postmenopausal women. Search for the trials was thorough and the data were analysed using standard methods. Presentation of the data and findings is clear.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Applicability of the results
- Implementation of the intervention
Research
References
This document should be cited as: Lakshmi Seshadri. Long-term hormone therapy for perimenopausal and postmenopausal women: RHL commentary (last revised: 6 Mars 2006). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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