Angela M. Cheung, MD, PhD
In younger postmenopausal women, does hormone therapy reduce mortality?
Included studies compared mortality in younger postmenopausal women (mean age < 60 y) who took hormone therapy (oral or transdermal estrogen or estrogen-progestin) and those who took placebo or no hormone therapy. Outcome was all-cause mortality.
MEDLINE, EMBASE/Excerpta Medica, CINAHL, and Cochrane Library (to Jan 2008); selected journals; and references were searched for prospective cohort studies that used multivariate analysis to adjust for confounding factors and randomized controlled trials (RCTs) ≥ 6 months in duration that reported ≥ 1 death. 8 observational studies (n = 212 171, mean follow-up 14 y) and 19 RCTs (n = 16 283, mean age 55 y, mean follow-up 5 y) met the selection criteria.
Estimates of the reduction in mortality with hormone therapy were similar in RCTs and observational studies (Table). The posterior probability of a mortality benefit from hormone therapy was 0.985 when only the results from RCTs were considered and 1.000 when the data from observational studies were added.
Consistent findings from observational studies and randomized trials show that hormone therapy reduces mortality in younger postmenopausal women.
Hormone therapy vs placebo or no hormone therapy (control) in younger postmenopausal women*
*CrI = credible interval, RCT = randomized controlled trial; other abbreviations defined in Glossary. RRR, NNT, and CrI calculated from data in article using a random-effects Bayesian model.
†The author points out that the absolute risk reduction, used to calculate the NNT, is an overestimation of the true figure because only trials reporting ≥ 1 death were included.
Cheung AM. Review: Hormone therapy reduces mortality in younger postmenopausal women. Ann Intern Med. ;152:JC4–9. doi: 10.7326/0003-4819-152-8-201004200-02009
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Published: Ann Intern Med. 2010;152(8):JC4-9.
Cardiology, Geriatric Medicine, Hematology/Oncology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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