Menopausal Hormone Therapy and Mortality: A Systematic Review and Meta-Analysis

Area of Science:

• Reproductive Medicine
• Oncology
• Cardiovascular Medicine

Background:

• Menopausal hormonal therapy (MHT) is widely used for managing menopausal symptoms.
• The impact of MHT on long-term mortality remains a critical area of investigation.

Purpose of the Study:

• To comprehensively assess the effect of MHT on all-cause and cause-specific mortality.
• To evaluate mortality risks associated with different MHT formulations and timing of initiation.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
• Searches included major databases (MEDLINE, EMBASE, Cochrane, Scopus) up to August 2013.
• Risk ratios and 95% confidence intervals were calculated using random-effects models.

Main Results:

• Meta-analysis of 43 RCTs indicated no overall effect of MHT on all-cause mortality (RR 0.99).
• No significant associations were found for cardiac death or stroke mortality.
• Estrogen plus progesterone MHT showed a potential increase in breast cancer mortality (RR 1.96), while estrogen-only MHT did not.
• MHT initiated in women under 60 or within 10 years of menopause was associated with reduced all-cause mortality (RR 0.70).

Conclusions:

• Current evidence suggests MHT does not alter overall mortality, or mortality from cardiac events, stroke, or most cancers.
• Estrogen plus progesterone therapy may be associated with an increased risk of breast cancer death.
• Early initiation of MHT in younger postmenopausal women may confer a survival benefit, warranting further research.