ECE2021 Audio Eposter Presentations General Endocrinology (51 abstracts)
Menopausal hormone therapy and women’s health: an umbrella review of systematic reviews and meta-analyses of randomized controlled trials and observational epidemiological studies
Guo-Qiang Zhang 1 , Jin-Liang Chen 2 , Ying Luo 3 , Maya B. Mathur 4 , Panagiotis Anagnostis 5 , Ulugbek Nurmatov 6 , Madar Talibov 7 , Jing Zhang 8 , Catherine M. Hawrylowicz 9 , Mary Ann Lumsden 10 , Hilary Critchley 11 , Aziz Sheikh 12 , Bo Lundbäck 1 , Cecilia Lässer 1 , Hannu Kankaanranta 1 , 13 , 14 , Siew Hwa Lee 15 & Bright I. Nwaru , 12 & 16
1Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Krefting Research Centre, Sweden; 2The First Affiliated Hospital of Chongqing Medical University, Department of Geriatrics, China; 3Children’s Hospital of Chongqing Medical University, Department of Gastroenterology, China; 4Stanford University, Quantitative Sciences Unit, United States; 5Medical School, Aristotle University of Thessaloniki, Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Greece; 6School of Medicine, Cardiff University, Division of Population Medicine, United Kingdom; 7Centre de Lutte Contre le Cancer François Baclesse, UMR1086 INSERM – Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers (ANTICIPE), France; 8Chongqing General Hospital, University of Chinese Academy of Sciences, Department of Intensive Care Unit, China; 9King’s College London, Guy’s Hospital, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, United Kingdom; 10Glasgow Royal Infirmary Campus of the School of Medicine, University of Glasgow, Section of Reproductive and Maternal Medicine, United Kingdom; 11Queen’s Medical Research Institute, University of Edinburgh, MRC Centre for Reproductive Health, United Kingdom; 12Usher Institute, University of Edinburgh, Asthma UK Centre for Applied Research, Centre for Medical Informatics, United Kingdom; 13Seinäjoki Central Hospital, Department of Respiratory Medicine, Finland; 14University of Tampere, Faculty of Medicine and Health Technology, Finland; 15Robert Gordon University, School of Nursing, Midwifery and Paramedic Practice, United Kingdom; 16University of Gothenburg, Wallenberg Centre for Molecular and Translational Medicine, Sweden
Importance
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.
Objective
To comprehensively summarize evidence on the benefits and harms of MHT across diverse health outcomes in women.
Data sources
MEDLINE, EMBASE and 10 other databases from inception to November 26, 2017, updated December 17, 2020.
Study selection
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), on any health outcome or indicator in perimenopausal or postmenopausal women in all countries and settings.
Data extraction and synthesis
Two investigators independently extracted data and assessed study quality. Random-effects robust variance estimation was used to combine effect estimates.
Main outcomes and measures
All health outcomes included in previous systematic reviews, including menopausal symptoms, surrogate endpoints, biomarkers, various morbidity outcomes, and mortality.
Results
Sixty systematic reviews were included, involving 102 meta-analyses of RCTs and 38 of observational studies, with 121 unique outcomes. The overall quality of included systematic reviews was moderate to poor. In meta-analyses of RCTs, MHT was beneficial for vasomotor symptoms (risk ratio [RR] 0.29, 95% confidence interval [CI] 0.17–0.50) and vaginal atrophy (intravaginal ET: RR 0.31, 95% CI 0.12–0.81), as well as sexual function, all fracture, vertebral and non-vertebral fracture, diabetes mellitus, cardiovascular mortality (ET) and colorectal cancer (EPT), but harmful for stroke (RR 1.17, 95% CI 1.05–1.29) and venous thromboembolism (RR 1.60, 95% CI 0.99–2.58), as well as cardiovascular disease, cerebrovascular disease, non-fatal stroke, deep vein thrombosis, gallbladder disease, 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 and ovarian cancer. ET and EPT had opposite effects for breast and endometrial cancer, endometrial hyperplasia and Alzheimer’s disease. Importantly, current evidence supporting the beneficial effects on coronary heart disease and all-cause mortality in young women (known as ’timing hypothesis’) is only tentative.
Conclusions and relevance
MHT has a complex balance of benefits and harms on multiple health outcomes. Some effects differ qualitatively between ET and EPT. Clinicians should evaluate the credibility of the methods of systematic reviews prior to considering applying their results in clinical practice. A re-examination of current practice guidelines may be needed.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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