LongTerm Effects of Hormone Replacement Therapy.
This large population-based matched cohort study examined the long-term effects of Hormone Replacement Therapy (HRT) on all-cause mortality in 105,199 healthy women aged 46-65 years at first prescription, compared with 224,643 matched healthy controls. The study used primary care data from the UK from 1984 to 2017 and had an average patient follow-up of 14 years.
"Estrogen-Only vs Combined HRT: The Impact on Mortality Risk"
The study found that estrogen-only HRT was not associated with a significant increase or decrease in the risk of all-cause mortality in any age group. However, combined HRT was associated with a significantly reduced risk of all-cause mortality.
"Strengths and Shadows: A Closer Look at the Research Design"
The study had several strengths such as a large sample size, utilization of electronic primary care records, and comprehensive adjustment for confounding factors. However, it also had limitations including potential residual confounding by unrecorded risk factors like age at menopause, parity, diet, physical activity, and HRT duration.
"Comparing HRT Studies: Aligning with Previous Findings"
In terms of interpretation, the findings partly aligned with previous studies such as the Women’s Health Initiative Trials and Stram et al., which also did not find an association of combined or estrogen-only HRT with all-cause, cardiovascular, or cancer mortality. But the new study differed in that it had a longer follow-up and the participants took various doses and preparations of oral and transdermal HRT.
"NICE Guidelines on HRT: Balancing Benefits and Risks in Decision-Making"
According to current NICE guidelines in the UK, combined HRT is recommended for symptomatic women with a uterus, and estrogen-only HRT for women without a uterus, after discussing the benefits and risks. This study supports the emerging consensus that the benefits of long-term HRT use outweigh the risks for most women. However, it also emphasizes that each woman should make an informed decision considering her own clinical condition, concerns, and expectations.
Another detail that seems neglected in these recommendations is that progesterone is beneficial for a woman’s body beyond the uterus.
Jason & Rita
