Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. Feb 10, 2016; 5(1): 127-133
Published online Feb 10, 2016. doi: 10.5317/wjog.v5.i1.127
Variation in use of menopausal hormone treatment on risk of health outcomes
Soo-Keat Khoo, Lee Tripcony
Soo-Keat Khoo, School of Medicine, University of Queensland and Royal Brisbane and Women’s Hospital, Brisbane, Queensland 4029, Australia
Lee Tripcony, Oncology Services, Royal Brisbane and Women’s Hospital, Brisbane, Queensland 4029, Australia
Author contributions: Khoo SK contributed to the concept and design of the study, assisted in patient supervision and wrote the manuscript; Tripcony L provided management of the data base and statistical analysis, and assisted in writing the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Royal Women’s Hospital and subsequently by the Royal Brisbane and Women’s Hospital (ref RWH 99/17) (see attached).
Informed consent statement: All study participants were given information about the study and provided informed written consent before recruitment and enrolment. All data were de-identified.
Conflict-of-interest statement: Both authors declare no conflict of interest in the findings of the study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Soo-Keat Khoo, MD, Professor, FRANZCOG, School of Medicine, University of Queensland, Royal Brisbane and Women’s Hospital, Level 6 Ned Hanlon Building, Brisbane, Queensland 4029, Australia. hoo@uq.edu.au
Telephone: +61-7-33655205 Fax: +61-7-33655211
Received: July 1, 2015
Peer-review started: July 8, 2015
First decision: September 18, 2015
Revised: October 12, 2015
Accepted: November 23, 2015
Article in press: November 25, 2015
Published online: February 10, 2016
Abstract

AIM: To determine the relative risk of selected serious outcomes with variations in use of menopausal hormone treatment (MHT).

METHODS: A cohort of 489 women, randomly recruited at age 40-79 years, from a longitudinal study of urbanised population was a study group and was followed for 14 years. Four selected outcomes (coronary artery disease, stroke, peripheral artery disease, breast cancer) were tested. Each woman on entry to the study was interviewed by a dedicated medical practitioner, and data on menstrual and menopausal history and health status were obtained. Outcome information was ascertained by questionnaire and medical reports from attending medical practitioners. In case of death, cause of death was checked with the Registry of Births, Deaths, Marriages and Divorce. This information was available for all women. An ever-user of MHT was defined as use for 6 mo or more at any time during the study. A late start of MHT was defined as 3 years or more from onset of menopause. The generalised linear statistical package was used to examine the data; univariate logistic regression models were used to describe the relationship between patient characteristics and a disease outcome, followed by stepwise multi variate analysis, controlling for age, lifestyle factors and co-morbidities.

RESULTS: The risk of ever-use of MHT was significantly increased only for peripheral artery disease (RR = 2.16; 0.99, 4.71; P = 0.05), and not for coronary artery disease, stroke and breast cancer. A late start of MHT (three years or more from onset of menopause) was associated with significantly increased risks for coronary artery disease (RR = 2.56; 1.15, 5.72; P = 0.02) and peripheral artery disease (RR = 4.42; 1.55, 12.64; P = 0.005), and use after age 60 years with significantly increased risks for coronary artery disease (RR = 4.98; 2.19, 11.55; P < 0.001), stroke (RR = 2.99; 1.11, 8.08; P = 0.03) and peripheral artery disease (RR = 4.18; 1.24, 14.14; P = 0.02). Use up to 10 years was not associated with significant risk for all outcomes. These risks were confirmed by stepwise multi variate analysis, adjusting for age at recruitment, body mass index, smoking, physical activity and alcohol use, and existing diabetes, mellitus, hypertension and hypercholesterolaemia. Regardless of variations in use, risk for breast cancer was not found.

CONCLUSION: The study confirms ever-use of MHT affected only risk of peripheral artery disease; but some use variations could have adverse effects.

Keywords: Menopausal hormone treatment, Variation in use, Risk outcomes

Core tip: In contrast to larger studies, this small observational study examined effects of various ways of use of menopausal hormone treatment (MHT) when given for clinical indications. Of the four selected outcomes available at 14 years follow-up, overall risk was only increased for peripheral artery disease but not for coronary artery disease, stroke and breast cancer. However, risk was increased for coronary artery disease and peripheral disease when MHT was started more than three years after menopause in women over 60 years.