Long-term hormone therapy for perimenopausal and postmenopausal women

Topic: Risk, prevention and care in population studies

We included 22 studies involving 43,637 women. We derived nearly 70% of the data from two well-conducted studies (HERS 1998; WHI 1998). Most participants were postmenopausal American women with at least some degree of comorbidity, and mean participant age in most studies was over 60 years. None of the studies focused on perimenopausal women.In relatively healthy postmenopausal women (i.e. generally fit, without overt disease), combined continuous HT increased the risk of a coronary event (after 1 year's use: from 2 per 1000 to between 3 and 7 per 1000), venous thromboembolism (after 1 year's use: from 2 per 1000 to between 4 and 11 per 1000), stroke (after 3 years' use: from 6 per 1000 to between 6 and 12 per 1000), breast cancer (after 5.6 years' use: from 19 per 1000 to between 20 and 30 per 1000), gallbladder disease (after 5.6 years' use: from 27 per 1000 to between 38 and 60 per 1000) and death from lung cancer (after 5.6 years' use plus 2.4 years' additional follow-up: from 5 per 1000 to between 6 and 13 per 1000).Oestrogen-only HT increased the risk of venous thromboembolism (after 1 to 2 years' use: from 2 per 1000 to 2 to 10 per 1000; after 7 years' use: from 16 per 1000 to 16 to 28 per 1000), stroke (after 7 years' use: from 24 per 1000 to between 25 and 40 per 1000) and gallbladder disease (after 7 years' use: from 27 per 1000 to between 38 and 60 per 1000) but reduced the risk of breast cancer (after 7 years' use: from 25 per 1000 to between 15 and 25 per 1000) and clinical fracture (after 7 years' use: from 141 per 1000 to between 92 and 113 per 1000) and did not increase the risk of coronary events at any follow-up time.Women over 65 years of age who were relatively healthy and taking continuous combined HT showed an increase in the incidence of dementia (after 4 years' use: from 9 per 1000 to 11 to 30 per 1000). Among women with cardiovascular disease, use of combined continuous HT significantly increased the risk of venous thromboembolism (at 1 year's use: from 3 per 1000 to between 3 and 29 per 1000). Women taking HT had a significantly decreased incidence of fracture with long-term use.Risk of fracture was the only outcome for which strong evidence showed clinical benefit derived from HT (after 5.6 years' use of combined HT: from 111 per 1000 to between 79 and 96 per 1000; after 7.1 years' use of oestrogen-only HT: from 141 per 1000 to between 92 and 113 per 1000). Researchers found no strong evidence that HT has a clinically meaningful i

@article{marjoribanks2017-28093732,
  author  = {Marjoribanks, J. and Farquhar, C. and Roberts, H. and Lethaby, A. and Lee, J.},
  title   = {{Long-term hormone therapy for perimenopausal and postmenopausal women}},
  journal = {The Cochrane database of systematic reviews},
  year    = {2017},
  doi     = {10.1002/14651858.cd004143.pub5},
  pmid    = {28093732},
  url     = {https://doi.org/10.1002/14651858.cd004143.pub5}
}

Key findings

• We included 22 studies involving 43,637 women.
• We derived nearly 70% of the data from two well-conducted studies (HERS 1998; WHI 1998).
• Most participants were postmenopausal American women with at least some degree of comorbidity, and mean participant age in most studies was over 60 years.
• None of the studies focused on perimenopausal women.In relatively healthy postmenopausal women (i.e. generally fit, without overt disease), combined continuous HT increased the risk of a coronary event (after 1 year's use: from 2 per 1000 to between 3 and 7 per 1000), venous thromboembolism (after 1
• Among women with cardiovascular disease, use of combined continuous HT significantly increased the risk of venous thromboembolism (at 1 year's use: from 3 per 1000 to between 3 and 29 per 1000).

Why it matters

This review of hormone therapy in postmenopausal women focused on risks such as coronary events, blood clots, stroke, breast cancer, and gallbladder disease. It does not report effects on Alzheimer's disease treatment, cure, or prevention.

New to this subject? Start with our plain-English guide: Prevention →

Study details

• Participants22
• Evidence strengthHigh

Read the original

• DOI: 10.1002/14651858.cd004143.pub5
• PubMed: 28093732
• Original source →
• Free full text: Cochrane Database of Systematic Reviews →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

Studies this one cites

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• Conjugated equine estrogens and global cognitive function in postmenopausal women: Women's Health Initiative Memory Study JAMA · 2004-06-01 · usefulness score 80/100 · How common it is
• Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative Memory Study JAMA · 2004-06-01 · usefulness score 80/100 · How common it is
• Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials JAMA · 2013-10-01 · usefulness score 80/100 · Prevention and risk
• Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial JAMA · 2003-05-01 · usefulness score 72/100 · Treatments
• Main morbidities recorded in the women's international study of long duration oestrogen after menopause (WISDOM): a randomised controlled trial of hormone replacement therapy in postmenopausal women BMJ (Clinical research ed.) · 2007-07-11 · usefulness score 70/100 · Prevention and risk
• Estrogen replacement therapy for treatment of mild to moderate Alzheimer disease: a randomized controlled trial. Alzheimer's Disease Cooperative Study JAMA · 2000-02-01 · usefulness score 67/100 · Treatments

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