What Health Outcomes are Associated with Hormone Therapy Use Beyond Age 65?
BACKGROUND AND PURPOSE:
- Baik et al. (Menopause, 2024) assessed the use of menopausal hormone therapy (HT) beyond age 65 years and its health implications by types of estrogen/progestogen, routes of administration, and dose strengths
METHODS:
- Retrospective cohort study
- CMS provided access to 100% claims data for Medicare Parts A (hospital), B (medical insurance), C (Medicare Advantage) and D (drug benefits)
- Population
- Women who were Medicare enrollees at age 65 during Part D benefits (2007 to 2020)
- Exposures
- HT type
- Estrogen: estradiol (E2) | Conjugated estrogen (CEE) | ethinyl estradiol (EE)
- Progestogen: progesterone (natural) | Progestin (synthetic)
- Routes: Oral | Transdermal | Vaginal | Injectable
- Dose
- HT type
- Study design
- Only included enrollees with ≥6 months follow-up
- Cox regression analyses were used, adjusted for time-varying characteristics of the women
- Primary outcome
- All-cause mortality | Cancer | Cardiovascular disease | Dementia
RESULTS:
- 10 million women
- Compared with never use or discontinuation of HT >65 years, the use of estrogen monotherapy >65 years was associated with significant risk reductions in
- Mortality: Adjusted hazard ratio (aHR) 0.81 (95% CI, 0.79 to 0.82)
- Breast cancer: aHR 0.84 (95% CI, 0.83 to 0.86)
- Lung cancer: aHR 0.87 (95% CI, 0.84 to 0.90)
- Colorectal cancer: aHR 0.88 (95% CI, 0.84 to 0.91)
- Congestive heart failure: aHR 0.95 (95% CI, 0.94 to 0.96)
- VTE: aHR 0.97 (95% CI, 0.96 to 0.98)
- Atrial fibrillation: aHR 0.96 (95% CI, 0.95 to 0.98)
- Acute myocardial infarction: aHR 0.89 (95% CI, 0.87 to 0.92)
- Dementia: aHR 0.98 (95% CI, 0.97 to 1.00)
- Combo-therapy with either progestin or progesterone was associated with increased risk of breast cancer
- E+progestin: aHR 1.10 (95% CI, 1.06 to 1.15)
- E+progesterone: aHR 1.19 (95% CI, 1.14 to 1.24)
- Combo-therapy with progestin exhibited significant risk reductions in
- Endometrial cancer: aHR 0.55 (95% CI, 0.50 to 0.60)
- Ovarian cancer: aHR 0.79 (95% CI, 0.71 to 0.89)
- Ischemic heart disease: aHR 0.95 (95% CI, 0.93 to 0.97)
- Congestive heart failure: aHR 0.95 (95% CI, 0.91 to 0.98)
- VTE: aHR 0.95 (95% CI, 0.91 to 0.99)
- Combo-therapy with progesterone exhibited risk reduction only in congestive heart failure
- aHR 0.96 (95% CI, 0.92 to 1.00)
CONCLUSION:
- Health implications of using hormone therapy beyond age 65 vary based on the type of HT, route of administration, and dose
- Benefits accrue to estrogen monotherapy, appropriate for women without an intact uterus
- It appears that risk for breast cancer is most reduced with lower doses, vaginal or transdermal administration and use of estradiol
- The authors state
Our study suggests the possibility of important health benefits with use of menopausal HT beyond age 65 years
…low dose of transdermal and vaginal EPT (especially E+ progestin) can mitigate the risk of breast cancer
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