Benefits and risks of postmenopausal hormone therapy when it is initiated soon after menopause.

Abstract

The authors further analyzed results from the Women's Health Initiative randomized trials (1993-2004) of conjugated equine estrogens, with or without medroxyprogesterone acetate, focusing on health benefits versus risks among women who initiated hormone therapy soon after menopause. Data from the Women's Health Initiative observational study (1993-2004) were included in some analyses for additional precision. Results are presented here for incident coronary heart disease, stroke, venous thromboembolism, breast cancer, colorectal cancer, endometrial cancer, or hip fracture; death from other causes; a summary global index; total cancer; and total mortality. Hazard ratios for breast cancer and total cancer were comparatively higher (P < 0.05) among women who initiated hormone therapy soon after menopause, for both regimens. Among these women, use of conjugated equine estrogens appeared to produce elevations in venous thromboembolism and stroke and a reduction in hip fracture. Estrogen plus progestin results among women who initiated use soon after menopause were similar for venous thromboembolism, stroke, and hip fracture but also included evidence of longer-term elevations in breast cancer, total cancer, and the global index. These analyses provide little support for the hypothesis of favorable effects among women who initiate postmenopausal estrogen use soon after menopause, either for coronary heart disease or for health benefits versus risk indices considered.

• Authors: Ross L Prentice, Joann E Manson, Robert D Langer, Garnet L Anderson, Mary Pettinger, Rebecca D Jackson, Karen C Johnson, Lewis H Kuller, Dorothy S Lane, Jean Wactawski-Wende, Robert Brzyski, Matthew Allison, Judith Ockene, Gloria Sarto, Jacques E Rossouw
• Journal: American journal of epidemiology (Am J Epidemiol) Vol. 170 Issue 1 Pg. 12-23 (Jul 01 2009) ISSN: 1476-6256 [Electronic] United States
• PMID: 19468079 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Contraceptive Agents, Female
• Estrogens
• Estrogens, Conjugated (USP)
• Progestins
• Medroxyprogesterone Acetate

Topics

• Aged
• Breast Neoplasms (epidemiology, prevention & control)
• Colorectal Neoplasms (epidemiology)
• Contraceptive Agents, Female (adverse effects, therapeutic use)
• Coronary Disease (epidemiology, prevention & control)
• Endometrial Neoplasms (epidemiology)
• Estrogen Replacement Therapy (adverse effects)
• Estrogens (adverse effects, therapeutic use)
• Estrogens, Conjugated (USP) (administration & dosage, adverse effects, therapeutic use)
• Female
• Follow-Up Studies
• Fractures, Bone (epidemiology, prevention & control)
• Humans
• Incidence
• Medroxyprogesterone Acetate (adverse effects, therapeutic use)
• Menopause
• Middle Aged
• Postmenopause (drug effects)
• Progestins (adverse effects, therapeutic use)
• Pulmonary Embolism (epidemiology)
• Retrospective Studies
• Risk Factors
• Stroke (epidemiology)
• Survival Rate (trends)
• Thrombosis (epidemiology)
• Time Factors
• Washington (epidemiology)