Long-term hormone therapy for perimenopausal and postmenopausal women

Area of Science:

• Endocrinology
• Gynecology
• Cardiovascular Medicine
• Oncology

Background:

• Hormone therapy (HT) is used for menopausal symptoms, cardiovascular disease, osteoporosis, and dementia in women.
• This is an updated Cochrane review assessing long-term HT effects.

Purpose of the Study:

• To evaluate the long-term impact of prolonged (≥1 year) hormone therapy use.
• Assessed outcomes include mortality, cardiovascular events, cancer, gallbladder disease, fractures, and cognition.
• Focused on perimenopausal and postmenopausal women.

Main Methods:

• Included randomized, double-blind trials of HT (estrogen +/- progestogen) versus placebo for ≥1 year.
• Searched multiple databases and trial registers up to September 2024.
• Two authors independently selected studies, assessed bias, and extracted data; certainty assessed using GRADE.

Main Results:

• 24 studies (45,660 participants), primarily postmenopausal American women >60 years.
• Combined HT: probable increase in breast cancer (RR 1.27), possible stroke (RR 1.39), possible venous thromboembolism (RR 2.03), probable fracture reduction (RR 0.78).
• Estrogen-only HT: probable increase in stroke (RR 1.33) and gallbladder disease (RR 1.78), probable fracture reduction (RR 0.73), little/no difference in coronary events and breast cancer.

Conclusions:

• Risk profiles differ between combined and estrogen-only HT.
• Estrogen-only HT: increased stroke/gallbladder disease, reduced fractures, neutral on coronary events/breast cancer.
• Combined HT: increased breast cancer/thromboembolism risk. Caution advised due to reliance on oral HT studies.