No increased death toll for long-term menopausal hormone therapy

Area of Science:

• Reproductive Endocrinology
• Clinical Trials
• Public Health

Background:

• Initial Women's Health Initiative (WHI) study findings focused on increased morbidity risks associated with postmenopausal hormone therapy (HT).
• Subsequent analyses highlighted the importance of age at initiation and duration of use, revealing a favorable safety profile for HT in healthy women starting near menopause.
• Long-term follow-up data from the WHI cohort now allow for comprehensive evaluation of mortality outcomes.

Purpose of the Study:

• To evaluate the long-term all-cause, cardiovascular, and cancer mortality risks associated with postmenopausal hormone therapy using data from the Women's Health Initiative (WHI) study.
• To provide a definitive assessment of hormone therapy safety based on extended follow-up of the WHI cohort.
• To inform rational prescribing decisions for postmenopausal hormone therapy.

Main Methods:

• Analysis of long-term follow-up data from the Women's Health Initiative (WHI) cohort.
• Evaluation of mortality records, including all-cause, cardiovascular, and cancer mortality.
• Assessment of hormone therapy regimens including conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) and CEE alone.

Main Results:

• Postmenopausal hormone therapy with CEE plus MPA (median 5.6 years) or CEE alone (median 7.2 years) was not associated with an increased risk of all-cause mortality.
• No increased risk of cardiovascular mortality was observed with either hormone therapy regimen.
• Cancer mortality risk was also not significantly associated with the use of CEE plus MPA or CEE alone during the follow-up period.

Conclusions:

• Long-term follow-up of the WHI study demonstrates that postmenopausal hormone therapy is not associated with increased all-cause, cardiovascular, or cancer mortality.
• The findings suggest that the previous concerns regarding the hazards of hormone therapy have been largely resolved by extensive data and long-term follow-up.
• These results support clear and rationalized prescribing decisions for postmenopausal hormone therapy in appropriate patient populations.