Protective effect of hormone therapy among women with hysterectomy/oophorectomy

Chen, L., Mishra, G. D., Dobson, A. J., Wilson, L. F. and Jones, M. A. (2017) Protective effect of hormone therapy among women with hysterectomy/oophorectomy. Human Reproduction, 32 4: 885-892. doi:10.1093/humrep/dex017

Author Chen, L.
Mishra, G. D.
Dobson, A. J.
Wilson, L. F.
Jones, M. A.
Title Protective effect of hormone therapy among women with hysterectomy/oophorectomy
Journal name Human Reproduction   Check publisher's open access policy
ISSN 1460-2350
Publication date 2017-04-01
Sub-type Article (original research)
DOI 10.1093/humrep/dex017
Open Access Status Not yet assessed
Volume 32
Issue 4
Start page 885
End page 892
Total pages 8
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Formatted abstract
Study question: Does exposure to menopausal hormone therapy (MHT) in mid-aged women alter their risk of cardiovascular disease (CVD) mortality and all-cause mortality

Summary answer: MHT soon after menopause is unlikely to increase the risk of CVD mortality or all-cause mortality and may have a protective effect for women with hysterectomy/oophorectomy.

What is known already: The balance of benefits and risks of MHT are currently unclear and may differ according to when treatment starts and whether women have an intact uterus.

Study design, size, duration: A total of 13 715 participants from the mid-aged population-based cohort (born 1946-1951) of the Australian Longitudinal Study on Women's Health (ALSWH) were followed from 1998 to 2013.

Participants/materials, setting, methods: The measures included cardiovascular and all-cause mortality, exposure to MHT and menopausal status (based on 3-yearly self-reports). Electronic prescriptions data on MHT were also available from mid-2002 onwards. At each follow-up survey wave, participants were classified as: An existing user of MHT, an initiator of MHT or a non-initiator of MHT.

Main results and the role of chance: After adjusting for confounding variables, existing users of MHT had a reduced risk (hazard ratio 0.63; 95% CI, 0.43-0.92) of CVD mortality compared with non-initiators. Insufficient evidence of an association was identified for initiators of MHT (0.66; 0.35-1.24). For all-cause mortality, risks were reduced for both initiators (0.69; 0.55-0.87) and existing users (0.80; 0.70-0.91). In a subgroup analysis, women with hysterectomy/oophorectomy had lower risks of CVD mortality for both initiators (0.14; 0.02-0.98) and existing users (0.55; 0.34-0.90), but no evidence of an association was found for women whose MHT commenced during or after menopause. Similarly for all-cause mortality, only the women with hysterectomy/oophorectomy had lower risks for both initiators (0.47; 0.31-0.70) and existing users (0.69; 0.58-0.82).

Limitations, reasons for caution: Limitations include the observational nature of the study, the small number of deaths, MHT use being self-reported and the classification of menopausal status also being based on self-reported information.

Wider implications of the findings: Women considering MHT soon after menopause can be reassured that the treatment is unlikely to increase their risk of CVD mortality or all-cause mortality.
Keyword Cardiovascular mortality
Longitudinal study
Menopausal hormone therapy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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