Abstract
Menopausal hormone therapy (MHT) is effective for menopausal symptoms, however, its use is also associated with risks of serious health conditions including breast, ovarian and endometrial cancer, stroke and venous thromboembolism. MHT-related health risks increase with longer durations of use. In Australia, while overall MHT use fell when risk-related findings were published in 2002, a significant number of women continue using MHT long-term. We aimed to examine socio-demographic, health-related and lifestyle characteristics in relation to post-2002 MHT use, and to compare use for <5 and ≥5 years. Data from 1,561 participants from an Australian, national, cross-sectional survey of women aged 50-69 in 2013 were analysed. Odds ratios (ORs) were calculated using logistic regression for characteristics related to overall MHT use post-2002 and multinomial logistic regression for associations between MHT duration of use [never/<5 years/≥5 years] and personal characteristics, adjusting for sociodemographic, reproductive, health and lifestyle factors. Post-2002 MHT use was associated with increasing age (p-trend<0.001), hysterectomy versus no hysterectomy (OR:2.55, 95%CI = 1.85-3.51), bilateral oophorectomy vs no oophorectomy (OR:1.66, 95%CI = 1.09-2.53), and ever- versus never-use of therapies other than MHT for menopausal symptoms (OR:1.93, 95%CI = 1.48-2.57). Women with prior breast cancer (OR:0.35, 95%CI = 0.17-0.74) and with more children (p-trend = 0.034) were less likely than other women to use MHT. Prior hysterectomy was more strongly associated with MHT use for ≥5 years than for <5 years (p = 0.004). Ever-use of non-MHT menopausal therapies was associated with MHT use for <5 years but not with longer-term use (p = 0.004). This study reinforces the need for MHT users and their clinicians to re-evaluate continued MHT use on an ongoing basis.
Highlights
During the perimenopausal and postmenopausal periods, the decline in hormonal levels can lead to vasomotor symptoms in 55% of women [1]
Long-term Menopausal hormone therapy (MHT) users who have had a hysterectomy would most likely be using estrogen-only therapy (ET); in an earlier analysis of the Learning how Australians Deal with menopause sYmptoms (LADY) cohort we found that 77% of hysterectomised current MHT users reported ET use [8]
In addition to MHT, a number of CAMs are available and commonly used by menopausal women. As some of these can be of concern, guidance needs to be provided towards evidence-based alternative therapies for alleviating menopausal symptoms, if MHT cannot be used
Summary
During the perimenopausal and postmenopausal periods, the decline in hormonal levels can lead to vasomotor symptoms in 55% of women [1]. Evidence from randomised trials and observational studies, from 2002 onwards, demonstrated that use of MHT increases the risk of a range of conditions including breast, ovarian and endometrial cancer, stroke, and venous thromboembolism [3,4] and that these risks increase with increasing duration of use in postmenopausal women 50 years of age and older [5] Taking this evidence into consideration, regulatory agencies changed their major recommendations around 2002–3, recommending use of MHT for menopausal symptoms only, in fully-informed women, using the use of the lowest dose of MHT possible for the shortest time [4,6]. The North American Menopause Society position statement in 2017 stated that ‘the risks differ for different women, depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is needed’; it recommended that treatment should be individualized with periodic re-evaluation for the benefits and risks of MHT continuation [7]
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