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Hormone Treatment Beginning Near the Onset of Menopause FREE

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This article was published online first at www.annals.org on 29 July 2014.

The full report is titled “Arterial Imaging Outcomes and Cardiovascular Risk Factors in Recently Menopausal Women. A Randomized Trial.” It is in the 19 August 2014 issue of Annals of Internal Medicine (volume 161, pages 249-260). The authors are S.M. Harman, D.M. Black, F. Naftolin, E.A. Brinton, M.J. Budoff, M.I. Cedars, P.N. Hopkins, R.A. Lobo, J.E. Manson, G.R. Merriam, V.M. Miller, G. Neal-Perry, N. Santoro, H.S. Taylor, E. Vittinghoff, M. Yan, and H.N. Hodis.

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Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

Ann Intern Med. 2014;161(4):I-19. doi:10.7326/P14-9027
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What is the problem and what is known about it so far?

After the onset of menopause, women may experience an increase in cardiovascular disease (CVD), such as coronary artery disease leading to heart attacks, in addition to hot flashes and other uncomfortable changes. Menopausal hormone therapy (MHT), sometimes called hormone replacement therapy, has been used to help alleviate symptoms of menopause, such as hot flashes. This therapy might also reduce a woman's risk for CVD, although a large clinical trial of this treatment in predominantly older menopausal women did not find such a benefit. It has been observed that women who were receiving MHT closer to the onset of menopause may have a lower rate of CVD. However, this information does not come from a clinical trial, which could more definitively establish whether such a benefit exists.

Why did the researchers do this particular study?

To find out whether starting MHT closer to the onset of menopause will reduce the risk for CVD.

Who was studied?

727 women aged 42 to 58 years who had onset of menopause within the past 3 years and did not have known CVD.

How was the study done?

Participants were randomly assigned to receive MHT (as 2 pills or a pill and a patch) or to receive placebo pills and patches. They continued MHT for up to 4 years. The researchers assessed whether the thickness of the carotid artery (a blood vessel in the neck) or the amount of calcium in the blood vessels of the heart changed during the study, because each of these factors is a marker of CVD. They also asked about menopausal symptoms, such as hot flashes.

What did the researchers find?

Thickening of the carotid arteries or the amount of calcium in the blood vessels of the heart did not differ between the treatment groups. The women who received MHT aspills and patches each reported fewer hot flashes than those who received only placebo.

What were the limitations of the study?

The study was too short to assess whether MHT might alter the number of clinical events (such as heart attack or stroke).

What are the implications of the study?

Four years of MHT started soon after menopause does not seem to alter the development of CVD, but more research is needed to assess longer-term treatment.





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