Menopausal Hormone Therapy Not Associated with Mortality Risk — Physician’s First Watch

Medical News |
September 13, 2017

Menopausal Hormone Therapy Not Associated with Mortality Risk

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Menopausal hormone therapy does not put women at increased risk for death, according to long-term follow-up from the Women's Health Initiative (WHI) randomized trials published in JAMA.

In the WHI, nearly 17,000 postmenopausal women with a uterus were randomized to receive either daily conjugated equine estrogens (CEE) plus medroxyprogesterone acetate, or placebo. An additional 11,000 women who'd had a hysterectomy were randomized to CEE alone or placebo.

During 18 years' follow-up — which included roughly 5–7 years of treatment and 11–12 years of post-intervention follow-up — 27% of the women died. Neither combination hormone therapy nor CEE alone was associated with all-cause mortality during the intervention or post-intervention phase. Findings were similar for cardiovascular and cancer mortality.

An editorialist calls the findings "compelling and reassuring." She concludes: "For women with troubling vasomotor symptoms, premature menopause, or early-onset osteoporosis, hormone therapy appears to be both safe and efficacious."

Reader Comments (3)

John Amato Nurse/NP/PA, Critical Care Medicine

What is the effect on cognitive abilities? The possible relationship to dementia after long term use? There have been some proposed relationship to the above but what further studies have been done?

Ellen Grant MBChB,DObstRCOG Physician, Obstetrics/Gynecology, Retired

The Women's Health Initiative studies were prematurely terminated because of increases in cancers and vascular diseases and therefore to prevent more deaths. However, most women had previously taken hormones before being enrolled to take hormones or placebo. This must result in underestimation of the adverse effects of ever use of these hormones. The incidences and mortality from breast and ovarian cancers decreased as MHT use fell after the early discontinuation of the combined progestin and estrogen WHI trial and estrogen only WHI trial. It is a pity to undo this benefit.

Ellen Lerner, BSN Other, Other

Glad to see this article. After 25 odd years I came off of sequential HRT. I since a year ago was having monthly painful cramps 3 years after having a D&C, but this month I went back on it every other day to see how I feel. There was no obvious reason for the cramps, although I have my suspicions, but the hot flashes are miserable and I'm not singing as well as I would like, which could be lack of hormones and maybe other reasons, but I'm not sure, so I am back on it part time to see what happens. No one seems to know for sure about hormone therapy into older age or how it affects singers, so I'm on self trial and error for whatever it is worth with conversation with my gynecologist.

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