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 |
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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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