XIE Mei-qing, XIE Xiao-qian. Benefits and Risks of Menopausal Hormone Therapy[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(2): 151-156. DOI: 10.12290/xhyxzz.2021-0130
Citation: XIE Mei-qing, XIE Xiao-qian. Benefits and Risks of Menopausal Hormone Therapy[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(2): 151-156. DOI: 10.12290/xhyxzz.2021-0130

Benefits and Risks of Menopausal Hormone Therapy

Funds: 

Chinese Preventive Medicine Association Special Research Funding for Prevention and Treatment of Female Pelvic Floor Disorders 201819126

More Information
  • Corresponding author:

    XIE Mei-qing  Tel: 86-20-81332131, E-mail: xiemq@mail.sysu.edu.cn

  • Received Date: January 28, 2021
  • Accepted Date: February 21, 2021
  • Available Online: April 15, 2021
  • Issue Publish Date: May 29, 2021
  • Menopausal hormone therapy (MHT) is a supplemental treatment with exogenous estrogen for women with ovarian failure to solve health problems related to low sex hormone. It is no doubt that MHT is beneficial for relieving menopausal symptoms, treating genitourinary atrophy of menopause, and preventing osteoporosis. MHT has undergone nearly 80 years of development, and understanding of its benefits and risks has been changing over time. Particularly, the publication of the report of mid-term research of Women's Health Initiative that is a randomized controlled trial in 2002 largely influenced the application of MHT globally. It was reported that the use of conjugated equine estrogens(CEE) and medroxyprogesterone acetate(MPA) was associated with increased risks of cardiovascular disease and breast cancer in old women, which reencouraged the exploration of benefits and risks of MHT to menopausal women in the past 18 years. Today, it is widely accepted that the effects of MHT are related to several factors, including age at which MHT is started, age when menopause occurs, the type, dosage and route of MHT, duration of treatment, health status, and whether MHT is standardized and well-managed. This article discussed the benefits and risks of MHT based on various guidelines, consensus and articles on MHT published in the past ten years.
  • [1]
    Stute P, Wildt L, Neulen J. The impact of micronized progesterone on breast cancer risk: a systematic review[J]. Climacteric, 2018, 21: 111-122. DOI: 10.1080/13697137.2017.1421925
    [2]
    Boardman HMP, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women[J]. Cochrane Database Syst Rev, 2015, (3): CD002229. DOI: 10.1002/14651858.CD002229.pub3/pdf/standard
    [3]
    陈蓉, 郁琦, 徐克惠, 等. 中国14家医院妇科门诊40~60岁患者绝经相关特征的调查[J]. 中华妇产科杂志, 2013, 48: 723-727. DOI: 10.3760/cma.j.issn.0529-567x.2013.10.002
    [4]
    Cintron D, Lipford M, Larrea-Mantilla L, et al. Efficacy of menopausal hormone therapy on sleep quality: systematic review and meta-analysis[J]. Endocrine, 2017, 55: 702-711. DOI: 10.1007/s12020-016-1072-9
    [5]
    Sarri G, Pedder H, Dias S, et al. Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause[J]. BJOG, 2017, 124: 1514-1523. DOI: 10.1111/1471-0528.14619
    [6]
    Geiger PJ, Eisenlohr-Moul T, Gordon JL, et al. Effects of perimenopausal transdermal estradiol on self-reported sleep, independent of its effect on vasomotor symptom bother and depressive symptoms[J]. Menopause, 2019, 26: 1318-1323. DOI: 10.1097/GME.0000000000001398
    [7]
    Zhang L, Ruan X, Cui Y, et al. Menopausal Symptoms and Associated Social and Environmental Factors in Midlife Chinese Women[J]. Clin Interv Aging, 2020, 15: 2195-2208. DOI: 10.2147/CIA.S278976
    [8]
    Biehl C, Plotsker O, Mirkin S. A systematic review of the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause[J]. Menopause, 2019, 26: 431-453. DOI: 10.1097/GME.0000000000001221
    [9]
    Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women[J]. Cochrane Database Syst Rev, 2016, (8): CD001500. http://www.ncbi.nlm.nih.gov/pubmed/14583935
    [10]
    Gandhi J, Chen A, Dagur G, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management[J]. Am J Obstet Gynecol, 2016, 215: 704-711. DOI: 10.1016/j.ajog.2016.07.045
    [11]
    Wells G, Tugwell P, Shea B, et al. Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women[J]. Endocrine reviews, 2002, 23: 529-539. DOI: 10.1210/er.2001-5002
    [12]
    Cauley JA, Robbins J, Chen Z, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial[J]. JAMA, 2003, 290: 1729-1738. DOI: 10.1001/jama.290.13.1729
    [13]
    Ran SY, Yu Q, Chen Y, et al. Prevention of postmeno-pausal osteoporosis in Chinese women: a 5-year, double-blind, randomized, parallel placebo-controlled study[J]. Climacteric, 2017, 20: 391-396. DOI: 10.1080/13697137.2017.1325459
    [14]
    Marjoribanks J, Farquhar C, Roberts H, et al. Long-term hormone therapy for perimenopausal and postmenopausal women[J]. Cochrane Database Syst Rev, 2017, 1: CD004143.
    [15]
    Botteri E, Støer NC, Sakshaug S, et al. Menopausal hormone therapy and colorectal cancer: a linkage between nationwide registries in Norway[J]. BMJ Open, 2017, 7: e17639. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695317/
    [16]
    Labadie JD, Harrison TA, Banbury B, et al. Postmeno-pausal Hormone Therapy and Colorectal Cancer Risk by Molecularly Defined Subtypes and Tumor Location[J]. JNCI Cancer Spectr, 2020, 4: a42. http://www.researchgate.net/publication/344253462_Postmenopausal_Hormone_Therapy_and_Colorectal_Cancer_Risk_by_Molecularly_Defined_Subtypes_and_Tumor_Location
    [17]
    Mauvais-Jarvis F, Manson JE, Stevenson JC, et al. Menopausal Hormone Therapy and Type 2 Diabetes Prevention: Evidence, Mechanisms, and Clinical Implications[J]. Endocr Rev, 2017, 38: 173-188. DOI: 10.1210/er.2016-1146
    [18]
    Javed AA, Mayhew AJ, Shea AK, et al. Association Between Hormone Therapy and Muscle Mass in Postmenopausal Women: A Systematic Review and Meta-analysis[J]. JAMA Netw Open, 2019, 2: e1910154. DOI: 10.1001/jamanetworkopen.2019.10154
    [19]
    Venetkoski M, Savolainen-Peltonen H, Rahkola-Soisalo P, et al. Increased cardiac and stroke death risk in the first year after discontinuation of postmenopausal hormone therapy[J]. Menopause, 2018, 25: 375-379. DOI: 10.1097/GME.0000000000001023
    [20]
    Kim JE, Chang JH, Jeong MJ, et al. A systematic review and meta-analysis of effects of menopausal hormone therapy on cardiovascular diseases[J]. Sci Rep, 2020, 10: 20631. DOI: 10.1038/s41598-020-77534-9
    [21]
    Rovinski D, Ramos RB, Fighera TM, et al. Risk of venous thromboembolism events in postmenopausal women using oral versus non-oral hormone therapy: A systematic review and meta-analysis[J]. Thrombosis Res, 2018, 168: 83-95. DOI: 10.1016/j.thromres.2018.06.014
    [22]
    Scarabin PY. Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis[J]. Climacteric, 2018, 21: 341-345. DOI: 10.1080/13697137.2018.1446931
    [23]
    Shao H, Breitner JC, Whitmer RA, et al. Hormone therapy and Alzheimer disease dementia: new findings from the Cache County Study[J]. Neurology, 2012, 79: 1846-1852. DOI: 10.1212/WNL.0b013e318271f823
    [24]
    Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial[J]. JAMA, 2002, 288: 321-333. DOI: 10.1001/jama.288.3.321
    [25]
    Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial[J]. JAMA, 2004, 291: 1701-1712. DOI: 10.1001/jama.291.14.1701
    [26]
    Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence[J]. Lancet, 2019, 394: 1159-1168. DOI: 10.1016/S0140-6736(19)31709-X
    [27]
    Gompel A, Plu-Bureau G. Progesterone, progestins and the breast in menopause treatment[J]. Climacteric, 2018, 21: 326-332. DOI: 10.1080/13697137.2018.1476483
    [28]
    Formoso G, Perrone E, Maltoni S, et al. Short-term and long-term effects of tibolone in postmenopausal women[J]. Cochrane Database Syst Rev, 2016, (10): CD008536. http://www.researchgate.net/publication/309120259_Short-term_and_long-term_effects_of_tibolone_in_postmenopausal_women
    [29]
    Stute P, Neulen J, Wildt L. The impact of micronized progesterone on the endometrium: a systematic review[J]. Climacteric, 2016, 19: 316-328. DOI: 10.1080/13697137.2016.1187123
    [30]
    Gompel A. Progesterone, progestins and the endometrium in perimenopause and in menopausal hormone therapy[J]. Climacteric, 2018, 21: 321-325. DOI: 10.1080/13697137.2018.1446932
    [31]
    Vargiu V, Amar ID, Rosati A, et al. Hormone replacement therapy and cervical cancer: a systematic review of the literature[J]. Climacteric, 2020: 1-8. doi: 10.1080/13697137.2020.1826426.
    [32]
    Beral V, Gaitskell K, Hermon C, et al. Menopausal hor-mone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies[J]. Lancet, 2015, 385: 1835-1842. DOI: 10.1016/S0140-6736(14)61687-1
    [33]
    Pergialiotis V, Pitsouni E, Prodromidou A, et al. Hormone therapy for ovarian cancer survivors: systematic review and meta-analysis[J]. Menopause, 2016, 23: 335-342. DOI: 10.1097/GME.0000000000000508
    [34]
    Kilander C, Lagergren J, Konings P, et al. Menopausal hormone therapy and biliary tract cancer: a population-based matched cohort study in Sweden[J]. Acta Oncol, 2019, 58: 290-295. DOI: 10.1080/0284186X.2018.1549367
    [35]
    Zhong G, Liu Y, Chen N, et al. Reproductive factors, menopausal hormone therapies and primary liver cancer risk: a systematic review and dose-response meta-analysis of observational studies[J]. Hum Reprod Update, 2016, 23: 126-138. DOI: 10.1093/humupd/dmw037
  • Cited by

    Periodical cited type(5)

    1. 张东梅,黄玉葵,郑文金,詹凤丽,曾文振,周利锴. 南宁市围绝经期女性对围绝经期知识认知的现状调查. 中国妇幼保健. 2024(10): 1825-1828 .
    2. 周俞余,高川,崔埔安,王亚平,何仲. 更年期综合征患者绝经激素治疗中医患共同决策质量的影响因素研究. 中国全科医学. 2023(33): 4181-4186 .
    3. 许骏,翟惟凯. 翟惟凯从肝肾论治围绝经期综合征的经验. 中华养生保健. 2023(19): 176-179 .
    4. 梁鹏晨,周紫艳,常庆,易清清,孙苗苗,唐晔翎,曹励欧,杨洁. 基于L1000数据集筛选骨质疏松症的潜在治疗化合物. 江苏大学学报(医学版). 2022(01): 1-7+12 .
    5. 韦利英,丁雷,方朝晖,李家云. 丁雷从肝肾论治围绝经期综合征经验. 中医药临床杂志. 2022(08): 1444-1447 .

    Other cited types(8)

Catalog

    Article Metrics

    Article views (800) PDF downloads (172) Cited by(13)
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return
    x Close Forever Close