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A comprehensive study involving nearly 900,000 women has revealed that menopausal hormone therapy (MHT) does not increase the risk of death. This finding, published in the BMJ on Thursday, is based on a long-term analysis of 876,805 Danish women observed from their 45th birthday over approximately 14 years.
The study initially indicated a higher mortality risk for women using MHT. However, the authors noted that after adjusting for influential factors, there was no significant difference in mortality risk. They further reported that prolonged MHT use, even beyond a decade, did not correlate with increased mortality.
Expert Concerns and Study Limitations
Despite these findings, some experts have raised concerns regarding the study’s methodology. Professor Susan Davis, an endocrinologist and head of Monash University’s Women’s Health Research Program, highlighted the absence of crucial factors such as smoking and obesity in the study’s analysis.
“Major factors that impact life expectancy, namely smoking and overweight/obesity, were not even considered or even mentioned as a study limitation,” Professor Davis stated.
She emphasized that while the study adjusted for various characteristics, the exclusion of these critical factors limits the findings, especially in the context of past concerns linking MHT to breast cancer and heart disease.
Survival Benefits and Cautions
The research also found that women who underwent bilateral oophorectomy for non-cancerous reasons between ages 45 and 54 experienced a notable survival benefit when using MHT, with up to a 34% reduction in mortality risk. However, Professor Davis expressed skepticism about this result, questioning the life expectancy data of the women studied.
“I really would not expect women who had their ovaries out for reasons other than cancer to have a life expectancy that is 10–13 years younger than the general population,” she explained.
This skepticism underscores the need for further investigation into the factors affecting the mortality of these women.
Current Developments in MHT
This study coincides with the recent addition of three new MHTs to the Pharmaceutical Benefits Scheme: Estrogel, Estrogel Pro, and Prometrium. Since their inclusion in March last year, over 363,000 women have been prescribed 1.5 million treatments.
Dr. Amy Dwyer, a research fellow at the National Breast Cancer Foundation, acknowledged the Danish study as providing “reassuring real-world evidence.” However, she stressed the importance of nuanced treatment approaches.
“For women with significant menopausal symptoms, especially those who lose ovarian function early through surgery, the balance of evidence suggests that hormone therapy can be both safe and beneficial,” Dr. Dwyer noted.
Future Directions and Individualized Treatment
The findings from this study emphasize the importance of personalized healthcare. Dr. Dwyer and other experts advocate for a nuanced understanding of hormone therapy, considering individual risk factors such as timing, indication, and specific hormone formulations.
Supporting this perspective, research led by Professor Davis last year highlighted the necessity for individualized approaches to MHT and the importance of shared decision-making between healthcare providers and patients.
As the medical community continues to evaluate the implications of MHT, these findings serve as a reminder of the complexity and individuality of treatment options for menopausal women. Ongoing research and dialogue will be crucial in refining these therapies to ensure safety and efficacy for all patients.
