Menopausal hormone therapy and women's health: An umbrella review

Autor: Maya B. Mathur, Jing Zhang, Hilary O. D. Critchley, Panagiotis Anagnostis, Siew Hwa Lee, Guo-Qiang Zhang, Jin Liang Chen, Ying Luo, Mary Ann Lumsden, Cecilia Lässer, Hannu Kankaanranta, Aziz Sheikh, Ulugbek Nurmatov, Bo Lundbäck, Catherine M. Hawrylowicz, Madar Talibov, Bright I Nwaru
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Epidemiology
law.invention
Mathematical and Statistical Techniques
0302 clinical medicine
Randomized controlled trial
law
Breast Tumors
Medicine and Health Sciences
030212 general & internal medicine
Pharmaceutics
Cancer Risk Factors
Estrogen Replacement Therapy
Statistics
Hormonal Therapy
General Medicine
Middle Aged
Metaanalysis
Research Assessment
Systematic review
Oncology
Research Design
030220 oncology & carcinogenesis
Meta-analysis
Physical Sciences
Observational Studies
Medicine
Hormonal therapy
Female
Menopause
Research Article
medicine.medical_specialty
Drug Research and Development
Systematic Reviews
Research and Analysis Methods
03 medical and health sciences
Breast cancer
Drug Therapy
Internal medicine
Breast Cancer
medicine
Humans
Clinical Trials
Statistical Methods
Pharmacology
business.industry
Surrogate endpoint
Cancers and Neoplasms
Estrogens
medicine.disease
Randomized Controlled Trials
Medical Risk Factors
Relative risk
Women's Health
Observational study
Progestins
Clinical Medicine
business
Mathematics
Zdroj: PLoS Medicine, Vol 18, Iss 8, p e1003731 (2021)
Zhang, G-Q, Chen, J-L, Luo, Y, Mathur, M B, Anagnostis, P, Nurmatov, U, Talibov, M, Zhang, J, Hawrylowicz, C M, Lumsden, M A, Critchley, H, Sheikh, A, Lundbäck, B, Lässer, C, Kankaanranta, H, Lee, S H & Nwaru, B I 2021, ' Menopausal hormone therapy and women's health : An umbrella review ', PLoS Medicine, vol. 18, no. 8, pp. e1003731 . https://doi.org/10.1371/journal.pmed.1003731
PLoS Medicine
ISSN: 1549-1676
1549-1277
Popis: Background There remains uncertainty about the impact of menopausal hormone therapy (MHT) on women’s health. A systematic, comprehensive assessment of the effects on multiple outcomes is lacking. We conducted an umbrella review to comprehensively summarize evidence on the benefits and harms of MHT across diverse health outcomes. Methods and findings We searched MEDLINE, EMBASE, and 10 other databases from inception to November 26, 2017, updated on December 17, 2020, to identify systematic reviews or meta-analyses of randomized controlled trials (RCTs) and observational studies investigating effects of MHT, including estrogen-alone therapy (ET) and estrogen plus progestin therapy (EPT), in perimenopausal or postmenopausal women in all countries and settings. All health outcomes in previous systematic reviews were included, including menopausal symptoms, surrogate endpoints, biomarkers, various morbidity outcomes, and mortality. Two investigators independently extracted data and assessed methodological quality of systematic reviews using the updated 16-item AMSTAR 2 instrument. Random-effects robust variance estimation was used to combine effect estimates, and 95% prediction intervals (PIs) were calculated whenever possible. We used the term MHT to encompass ET and EPT, and results are presented for MHT for each outcome, unless otherwise indicated. Sixty systematic reviews were included, involving 102 meta-analyses of RCTs and 38 of observational studies, with 102 unique outcomes. The overall quality of included systematic reviews was moderate to poor. In meta-analyses of RCTs, MHT was beneficial for vasomotor symptoms (frequency: 9 trials, 1,104 women, risk ratio [RR] 0.43, 95% CI 0.33 to 0.57, p < 0.001; severity: 7 trials, 503 women, RR 0.29, 95% CI 0.17 to 0.50, p = 0.002) and all fracture (30 trials, 43,188 women, RR 0.72, 95% CI 0.62 to 0.84, p = 0.002, 95% PI 0.58 to 0.87), as well as vaginal atrophy (intravaginal ET), sexual function, vertebral and nonvertebral fracture, diabetes mellitus, cardiovascular mortality (ET), and colorectal cancer (EPT), but harmful for stroke (17 trials, 37,272 women, RR 1.17, 95% CI 1.05 to 1.29, p = 0.027) and venous thromboembolism (23 trials, 42,292 women, RR 1.60, 95% CI 0.99 to 2.58, p = 0.052, 95% PI 1.03 to 2.99), as well as cardiovascular disease incidence and recurrence, cerebrovascular disease, nonfatal stroke, deep vein thrombosis, gallbladder disease requiring surgery, and lung cancer mortality (EPT). In meta-analyses of observational studies, MHT was associated with decreased risks of cataract, glioma, and esophageal, gastric, and colorectal cancer, but increased risks of pulmonary embolism, cholelithiasis, asthma, meningioma, and thyroid, breast, and ovarian cancer. ET and EPT had opposite effects for endometrial cancer, endometrial hyperplasia, and Alzheimer disease. The major limitations include the inability to address the varying effects of MHT by type, dose, formulation, duration of use, route of administration, and age of initiation and to take into account the quality of individual studies included in the systematic reviews. The study protocol is publicly available on PROSPERO (CRD42017083412). Conclusions MHT has a complex balance of benefits and harms on multiple health outcomes. Some effects differ qualitatively between ET and EPT. The quality of available evidence is only moderate to poor.
In an umbrella review, Guo-Qiang Zhang and colleagues comprehensively summarize evidence on the benefits and harms of menopausal hormone therapy across diverse health outcomes.
Author summary Why was this study done? By 2050, it is estimated that worldwide more than 1.6 billion women will have reached menopause or be postmenopausal, up from 1 billion in 2020. Up to 75% of menopausal women are affected by bothersome menopausal symptoms, such as hot flashes and night sweats. Menopausal hormone therapy (MHT) is the most effective treatment for alleviating menopausal symptoms, but its effects on numerous health outcomes remain uncertain. What did the researchers do and find? We included 60 published systematic reviews of MHT use in menopausal women, involving 102 meta-analyses of randomized controlled trials and 38 of observational studies, and synthesized the evidence on 102 health outcomes. Overall, MHT had a complex balance of benefits and harms; for example, beyond alleviation of menopausal symptoms, it was associated with decreased risks of bone fracture, diabetes mellitus, and esophageal, gastric, and colorectal cancer, but increased risks of stroke, venous thromboembolism, gallbladder disease, and breast and ovarian cancer. The available clinical data in support of MHT reducing the risk of coronary heart disease and all-cause mortality in women aged
Databáze: OpenAIRE
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