September 12, 2017

expert reaction to study reporting that HRT is not associated with long-term mortality

In a new study, published in JAMA, scientists report that among postmenopausal women, hormone therapy was not associated with risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years.

A Before the Headlines analysis accompanied this roundup.

Prof. Paul Pharoah, Professor of Cancer Epidemiology, University of Cambridge, said:

“This paper reports the results from the long term follow-up of participants in a well-known randomised controlled trial.  As such the findings represent high quality evidence and the headline findings reported in the abstract and the press release are a good summary of the important findings.

“The benefits and harms of hormone replacement therapy for women with symptoms of the menopause have been debated for many years.  All-cause mortality (that is total mortality whatever the cause of death)  is one of the best measures of overall harm/benefit because it is a “hard” endpoint that can be accurately ascertained without any bias.  The results of this study shows that in the long term five to seven years of hormone replacement therapy for symptoms of the menopause is not associated with either an increase or a decrease in total mortality.

“While these data are important evidence that short term hormone replacement therapy is not associated with an increase in mortality overall, they are unlikely to change the current recommendations of the National Institute for Health and Care Excellence guidelines for the diagnosis and management of the menopause (https://www.nice.org.uk/guidance/ng23). The guidelines state that HRT is a useful treatment for menopausal symptoms because the weight of evidence from previous research suggests some harms and some benefits in terms of mortality, with clear benefits for treating the symptoms of menopause. This new study confirms that the mortality harms and benefits seem to be balanced.”

* ‘Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women’s Health Initiative Randomized Trials’ by Manson et al. published in JAMA on Tuesday 12 September.

Declared interests

Prof. Paul Pharoah: “I have no conflicts of interest to declare.”