This sparked debate regarding potential benefits and harm of HRT.
A new article published in The American Journal of Medicine conducted a meta-analysis of the available data using Bayesian methods and concluded that HRT almost certainly decreases mortality in younger postmenopausal women.
Their Bayesian analysis uses prior data, updated with new information, to make statistical inferences. The authors pooled results from 19 randomized trials that included age-specific data from the WHI, with 16,000 younger postmenopausal women (mean age 55 years) followed for 83,000 patient-years, and showed a mortality relative risk of 0.73. When data from 8 observational studies were added to the analysis, the resultant relative risk was 0.72.
Using Bayesian analysis to synthesize their data, they found the probability of a mortality benefit in this population was 1.0. This means that the probability of the hypothesis that hormone therapy reduces total mortality in younger women is essentially 1, statistical unity.
Writing in the article, Shelley R. Salpeter, MD, said, "It is clear that these findings need to be interpreted in the light of potential benefits and harms of hormone therapy. The available evidence indicates that hormone therapy in younger postmenopausal women increases the risk of breast cancer and pulmonary embolism and reduces the risk of cardiovascular events, colon cancer, and hip fracture. The cardiovascular benefit is a result of a small absolute increase in stroke and a greater reduction in coronary heart disease events. The total mortality benefit for younger women seen in the randomized trials and observational studies indicates that the reduction in deaths from coronary heart disease, fracture, and colon cancer outweighed the increase in deaths from breast cancer, stroke and pulmonary embolism. In addition to this mortality benefit, hormone therapy in younger women provides an improvement in quality-of-life measures, at least in the first few years of treatment."
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