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Permanent cessation of menses and postmenopausal hormone use in dialysis-dependent women: the HELP study
Holly Mattix Kramer1, Gary C Curhan, Ajay Singh
1Department of Medicine, Division of Nephrology, Loyola University Medical Center, Maywood, IL, USA.
Insights
Many women with end-stage renal disease (ESRD) experience early surgical menopause, increasing cardiovascular disease risk. Postmenopausal hormone therapy use is low and potentially risky for these patients.
Area of Science:
- Nephrology
- Cardiology
- Gynecology
Background:
- Early menopause, particularly surgical menopause, elevates cardiovascular disease (CVD) risk.
- Cardiovascular disease is a leading cause of death in women with end-stage renal disease (ESRD).
- Limited data exists on menopause timing and reasons in women with ESRD.
Purpose of the Study:
- To investigate the age and reasons for menopause cessation in women with ESRD.
- To determine the prevalence of surgical menopause and postmenopausal hormone (PMH) use in this population.
- To explore women's views on PMH therapy prescribed by nephrologists.
Main Methods:
- Utilized data from the Hemodialysis and Estrogen Levels in Postmenopausal Patients Study.
- Examined age at menopause, reasons for cessation, and surgical menopause prevalence.
- Assessed current/past PMH use and physician recommendations among dialysis-dependent women.
Main Results:
- Median age of menopause cessation was 48 years among 238 women.
- 30% experienced surgical menopause; 71% of those with bilateral oophorectomy were menopausal before 35.
- PMH use was low (6% current, 17% past); 54% would decline PMH from their kidney doctor.
Conclusions:
- Early surgical menopause is common in women with ESRD, potentially contributing to high CVD mortality.
- Postmenopausal hormone therapy use is infrequent and may pose significant cardiovascular risks in this high-risk group.
- The risks of PMH therapy may outweigh benefits for postmenopausal women on dialysis.
Background:
Earlier onset of menopause is associated with an increased risk for cardiovascular disease, especially among women with surgical menopause. Information on age at or reasons for the permanent cessation of menses among women with end-stage renal disease (ESRD) remains limited, although cardiovascular disease accounts for more than half of all cardiovascular deaths in this population.
Methods:
We used data from the Hemodialysis and Estrogen Levels in Postmenopausal Patients Study to examine the reported age when menses permanently ceased, reasons for the permanent cessation of menses, and prevalence of surgical menopause. We also investigated the frequency of current and past postmenopausal hormone (PMH) use among dialysis-dependent women and their views toward PMH therapy.
Results:
Among 238 postmenopausal hemodialysis-dependent women, median age when menses permanently ceased was 48 years. Permanent cessation of menses was attributed to natural causes in 65%, surgical reasons in 30% (16%, hysterectomy without bilateral oophorectomy; 14%, hysterectomy with bilateral oophorectomy), kidney failure in 2%, radiation or chemotherapy in 1%, and other causes in 2%. Among women with a history of bilateral oophorectomy, 71% became menopausal before the age of 35 years. Current and past PMH use was reported by 6% and 17% of the women, respectively, whereas 77% were never administered hormones. Only 2% stated a kidney doctor ever recommended PMH therapy, and 54% said they would not take PMHs if prescribed by their kidney doctor.
Conclusion:
Many women with ESRD experience surgical menopause before the age of 35 years, which may contribute to the excess cardiovascular mortality among women with ESRD. PMH use remains low among dialysis-dependent women. However, two randomized controlled trials have noted a significantly increased risk for cardiovascular events in women administered estrogen in combination with progestin. Thus, risks associated with PMH use may outweigh the benefits in a population with a very high rate of cardiovascular disease, such as postmenopausal hemodialysis-dependent women.
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