From the Lister Hill National Center for Biomedical Communications, National Library of Medicine, US National Institutes of Health, Bethesda, MD.
Menopause. 2024 May 1;31(5):363-371. doi: 10.1097/GME.0000000000002335. Epub 2024 Mar 9.
The study aims to assess the use of menopausal hormone therapy beyond age 65 years and its health implications by types of estrogen/progestogen, routes of administration, and dose strengths.
Using prescription drug and encounter records of 10 million senior Medicare women from 2007-2020 and Cox regression analyses adjusted for time-varying characteristics of the women, we examined the effects of different preparations of menopausal hormone therapy on all-cause mortality, five cancers, six cardiovascular diseases, and dementia.
Compared with never use or discontinuation of menopausal hormone therapy after age 65 years, the use of estrogen monotherapy beyond age 65 years was associated with significant risk reductions in mortality (19% or adjusted hazards ratio, 0.81; 95% CI, 0.79-0.82), breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (CHF) (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), and dementia (2%). For the use of estrogen and progestogen combo-therapy, both E+ progestin and E+ progesterone were associated with increased risk of breast cancer by 10%-19%, but such risk can be mitigated using low dose of transdermal or vaginal E+ progestin. Moreover, E+ progestin exhibited significant risk reductions in endometrial cancer (45% or adjusted hazards ratio, 0.55; 95% CI, 0.50-0.60), ovarian cancer (21%), ischemic heart disease (5%), CHF (5%), and venous thromboembolism (5%), whereas E+ progesterone exhibited risk reduction only in CHF (4%).
Among senior Medicare women, the implications of menopausal hormone therapy use beyond age 65 years vary by types, routes, and strengths. In general, risk reductions appear to be greater with low rather than medium or high doses, vaginal or transdermal rather than oral preparations, and with E2 rather than conjugated estrogen.
本研究旨在评估 65 岁以上女性使用不同类型的雌孕激素、给药途径和剂量的绝经激素治疗（MHT）的情况及其对健康的影响。
我们利用 2007 年至 2020 年期间 1000 万 Medicare 女性的处方药和就诊记录，并采用 Cox 回归分析调整了女性随时间变化的特征，考察了不同 MHT 制剂对全因死亡率、五种癌症、六种心血管疾病和痴呆的影响。
与 65 岁以后从未使用或停止使用 MHT 相比，65 岁以后使用单纯雌激素治疗与死亡率显著降低相关（19%，调整后的危险比为 0.81；95%CI，0.79-0.82）、乳腺癌（16%）、肺癌（13%）、结直肠癌（12%）、充血性心力衰竭（CHF）（5%）、静脉血栓栓塞（3%）、心房颤动（4%）、急性心肌梗死（11%）和痴呆（2%）。对于雌孕激素联合治疗的使用，E+孕激素和 E+孕酮均与乳腺癌风险增加 10%-19%相关，但使用低剂量经皮或阴道 E+孕激素可降低这种风险。此外，E+孕激素可显著降低子宫内膜癌（45%，调整后的危险比为 0.55；95%CI，0.50-0.60）、卵巢癌（21%）、缺血性心脏病（5%）、CHF（5%）和静脉血栓栓塞（5%）的风险，而 E+孕酮仅降低 CHF 的风险（4%）。
在 Medicare 老年女性中，65 岁以后使用 MHT 的影响因类型、途径和剂量而异。一般来说，低剂量似乎比中或高剂量、阴道或经皮制剂以及雌二醇比结合雌激素的风险降低效果更大。
