New Analysis Suggests Decreased Mortality from Hormone Replacement Therapy in Younger Postmenopausal Women

Researchers from Stanford University, McMaster University, California Institute of Technology, and Cornell University have reported that hormone replacement therapy (HRT) may reduce mortality by 28% in younger postmenopausal women. The details of this study appeared in the November 2009 issue of the American Journal of Medicine.[1]

Prior to 2002, HRT with estrogen plus progestin was often used to treat menopausal symptoms and to prevent osteoporosis and subsequent bone fractures. There was also conflicting evidence that HRT prevented heart disease. The association between HRT and breast and uterine cancer has been well known, but these cancers usually present in early stages and do not affect survival. Estrogen and progestin were usually given together for women who had an intact uterus in order to prevent uterine cancer. Women who had had a hysterectomy usually were given estrogen alone.

In 2002, researchers affiliated with the Women's Health Initiative reported that HRT was not associated with prevention of heart disease, although overall survival was not affected one way or the other. These results were published in the July 17, 2002 issue of the Journal of the American Medical Association. Since the publication of this study there has been a marked decline in the use of HRT for the treatment of menopausal symptoms and possibly a decline in the incidence of breast cancer. A follow-up of this study showed a trend for reduced mortality in women 50-59 years of age taking HRT compared with controls, with an HR of 0.70 (p for trend = 0.06).[2]

The current study included 19 randomized trials of HRT in women <60 years of age from 1966 to 2008 that included at least six months of HRT. The total number of women in this analysis was 16,000, with a mean age of 55 years. These women were followed for 83,000 patient years. The relative risk for mortality was 0.73 in women taking HRT compared with controls. When the data from eight observational studies were included, the relative risk for mortality was 0.72. These authors concluded that HRT reduces mortality in younger postmenopausal women. They caution: “This finding should be interpreted taking into account the potential harms of hormone therapy.”

Comments: This study is bound to cause much comment in the literature and further confusion in women about whether or not HRT is appropriate therapy for menopausal symptoms.

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