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The Risk of Cardiovascular Disease, Fracture, Dementia, and Cancer After Long-Term Hormone Therapy in Perimenopausal and Postmenopausal Women

 

Am Fam Physician. 2018 Jul 15;98(2):117-118.

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Details for This Review

Study Population: Perimenopausal and postmenopausal women with a mean age range of 48 to 76 years. Patients who took estrogen-only or combined hormone therapy were included.

Efficacy End Points: Reduction in fracture risk

Harm End Points: Mortality, coronary artery disease, cancer (breast, lung, colorectal, endometrial), gallbladder disease, fracture, cognitive function

Narrative: Long-term hormone therapy has been used in perimenopausal and postmenopausal women to treat many medical conditions. As levels of estrogen decrease naturally throughout menopause, women experience an increase in coronary artery disease, cancer, fractures, and many other conditions. This review evaluates the impact of long-term hormone therapy on the incidence of these conditions.

Long-term hormone therapy decreased the risk of all fractures, including hip and vertebral fractures. However, the risks far outweighed the benefits of this intervention. The most striking risk was an increase in the diagnosis of probable dementia in patients receiving combined estrogen/progesterone therapy. Patients had an increased risk of coronary events, venous thromboembolism, breast cancer, gallbladder disease, and death from lung cancer. Patients who received estrogen-only therapy had an increased risk of stroke, but there was no statistically significant difference in the combined treatment group. Estrogen-only therapy showed a decrease in breast cancers at seven years despite an increased risk among all patients included in the study.1

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LONG-TERM HORMONE THERAPY IN PERIMENOPAUSAL AND POSTMENOPAUSAL WOMEN

BenefitsHarms

1 in 42 women avoided a fracture

1 in 111 women were at increased risk of dementia

1 in 250 women died from lung cancer

1 in 500 women experienced a coronary event

1 in 200 women experienced a venous thromboembolism

1 in 200 women were diagnosed with breast cancer

1 in 91 women experienced gallbladder disease

LONG-TERM HORMONE THERAPY IN PERIMENOPAUSAL AND POSTMENOPAUSAL WOMEN

BenefitsHarms

1 in 42

Author disclosure: No relevant financial affiliations

Reference

1. Majoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2017;(1):CD004143.

 

 

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