AHRQ releases report on menopausal hormone therapy

The Agency for Healthcare Research and Quality (AHQR) released a recent report that systematically reviewed all of the studies published on hormone therapy for the primary prevention of chronic conditions during menopause. Here are excerpts from their report. It’s written for prescribers, but I think many in the lay audience will benefit from it. 

Abstract

Background: Menopausal hormone therapy to prevent chronic conditions is currently not recommended because of its adverse effects.

Purpose: To update evidence about the effectiveness of hormone therapy in reducing risk for chronic conditions and adverse effects, and to examine whether outcomes vary among women in different subgroups.

Data Sources: MEDLINE (January 2002 to November 2011), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the 3rd quarter of 2011), Scopus, and reference lists.

Study Selection: Randomized, placebo-controlled trials of menopausal hormone therapy published in English since 2002 that assessed primary prevention of chronic conditions.

Data Extraction: Investigators extracted data on participants, study design, analysis, follow-up, and results; 2 investigators independently rated study quality by using established criteria.

Data Synthesis: 9 fair-quality trials met the inclusion criteria. The Women’s Health Initiative reported most of the results, had 11 years of follow-up, and had data most applicable to postmenopausal women in the United States.

Results showed that estrogen plus progestin:

  • reduced
    • fractures (46 fewer per 10,000 woman-years) and
    • increased
      • invasive breast cancer (8 more per 10,000 woman-years),
      • stroke (9 more per 10,000 woman-years),
      • deep venous thrombosis (12 more per 10,000 woman-years),
      • pulmonary embolism (9 more per 10,000 woman-years),
      • lung cancer death (5 more per 10,000 woman-years),
      • gallbladder disease (20 more per 10,000 woman-years),
      • dementia (22 more per 10,000 woman-years), and
      • urinary incontinence (872 more per 10,000 woman-years).

Results showed that estrogen-only therapy

  • reduced
    • fractures (56 fewer per 10,000 woman-years) and
    • invasive breast cancer incidence (8 fewer per 10,000 woman-years) and
    • death (2 fewer per 10,000 woman-years) and
    • increased
      • stroke (11 more per 10,000 woman-years),
      • deep venous thrombosis (7 more per 10,000 woman-years),
      • gallbladder disease (33 more per 10,000 woman-years), and
      • urinary incontinence (1271 more per 10,000 woman-years).

Outcomes did not consistently differ by age or comorbid conditions.

Limitations: Limitations of the trials included low adherence, high attrition, inadequate power to detect risks for some outcomes, and evaluation of few regimens.

Conclusion: Estrogen plus progestin and estrogen alone decreased risk for fractures but increased risk for stroke, thromboembolic events, gallbladder disease, and urinary incontinence. Estrogen plus progestin increased risk for breast cancer and probable dementia, whereas estrogen alone decreased risk for breast cancer.

Primary Funding Source: Agency for Healthcare Research and Quality.

Internet Citation: Nelson HD, Walker M, Zakher B, Mitchell J. Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: A Systematic Review to Update the USPSTF Recommendations. AHRQ Publication No. 12-05168-EF-3. May 2012.

http://www.uspreventiveservicestaskforce.org/uspstf12/menohrt/menohrtart.htm

[Link to free full-text USPSTF report online]

USPSTF Program Office 
AHRQ Home Page

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2 Responses to AHRQ releases report on menopausal hormone therapy

  1. Becky says:

    What about post menopausal women who have had complete hysterectomy taking estrogen and testosterone? Have there been any studies using this combination? Also, seems I heard some conversation about testosterone and dementia some time back. Any valid info about this? Not sure I can afford to loose any memory capability! ;)

  2. Dr. Walt says:

    Hi Becky,

    Testosterone is increasingly used as part of postmenopausal hormone therapy regimens — and nearly a hundred studies a year have been published about postmenopausal testosterone use of the last few years. Unfortunately, few testosterone preparations are designed specifically for use in women. In addition, there are ongoing concerns surrounding the potential long-term negative effects of testosterone therapy.

    Walt

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