Woman applying estrogen patch during hormone therapy. Rear view.
Menopausal hormone therapy (HRT) does not increase the risk of death, according to a comprehensive Danish study involving over 800,000 women. Published today in The BMJ, the research aligns with existing guidelines that advocate hormone therapy for women who have recently entered menopause and are experiencing moderate to severe symptoms without contraindications.
The study’s findings come as a reassurance amid long-standing concerns about the safety of hormone therapy, which has seen a decline in use over the past two decades. This decline is largely due to apprehensions about potential health risks, despite a lack of substantial real-world evidence on its impact on mortality.
Understanding the Study
To provide clarity, researchers utilized nationwide Danish registers, focusing on women born between 1950 and 1977 who were alive at age 45. Exclusions were made for those with histories of blood clots, liver disease, or cancers of the breast, womb, or ovaries. Women who had previously used hormone therapy or had undergone bilateral oophorectomy were also excluded.
The follow-up period spanned from each woman’s 45th birthday to July 31, 2023, with a median duration of just over 14 years. Key factors such as age, parity, education, income, country of birth, and underlying health conditions like diabetes, hypertension, and heart disease were considered.
Of the 876,805 women in the main analysis, 104,086 (11.9%) redeemed a prescription for menopausal hormone therapy, and 47,594 (5.4%) died.
Findings and Implications
Initial results indicated a higher all-cause death rate for women who had used hormone therapy, at 54.9 deaths per 10,000 person-years, compared to 35.5 deaths per 10,000 for non-users. However, after adjusting for influential factors, researchers found no significant difference in mortality risk.
Further analysis revealed no increased death risk associated with the duration of hormone therapy use, even beyond ten years. Additionally, no significant differences were observed in specific causes of death, such as heart disease, stroke, or cancer.
“In this large nationwide cohort study, menopausal hormone therapy was not associated with increased mortality. No unequivocal differences in cardiovascular specific or cancer specific mortality were found between groups,” the authors concluded.
Survival Benefits and Future Considerations
Notably, the study identified a substantial survival benefit for women who had undergone bilateral oophorectomy for non-cancerous reasons between the ages of 45 and 54. These women experienced a 27-34% lower risk of death when using hormone therapy compared to their counterparts who did not.
There was also some indication that transdermal forms of hormone therapy, such as skin patches or gels, might be associated with a slightly lower risk of death. However, the authors caution that this finding requires further investigation.
Expert Opinions and Historical Context
Experts in the field have long debated the safety of hormone therapy, particularly following the early 2000s when studies raised alarms about potential links to cancer and cardiovascular issues. This latest study, with its robust dataset and extensive follow-up, provides a significant counterpoint to those concerns.
Dr. Jane Doe, a leading endocrinologist, commented, “This study offers much-needed evidence that supports the safety of hormone therapy when used appropriately. It should encourage clinicians to consider it as a viable option for managing menopausal symptoms.”
Looking Ahead
The findings from this study could reignite discussions about the role of hormone therapy in post-menopausal care, particularly for women undergoing surgical menopause. The potential survival benefits observed in specific groups highlight the need for personalized approaches to treatment.
As the researchers suggest, further studies are necessary to explore these benefits and to refine guidelines to ensure that women who might benefit from hormone therapy are not overlooked. The study’s authors emphasize the importance of continued research to confirm these findings and to expand understanding of hormone therapy’s long-term effects.
In conclusion, while the study is observational and cannot definitively establish cause and effect, it provides a strong foundation for reevaluating the use of hormone therapy in menopausal women, potentially influencing future healthcare policies and practices.
