Pattern of mortality after menopausal hormone therapy: long-term follow-up in a population based cohort

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  • Marianne Holm, Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark., Danmark
  • Anja Olsen
  • Shiu Lun Au Yeung, State Key Laboratory of Emerging Infectious Diseases and School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
  • Kim Overvad
  • Øjvind Lidegaard, Gynecological Clinic, Juliane Marie Center, Rigshospitalet, University of Copenhagen, Denmark., Danmark
  • Niels Kroman, d Department of Breast Surgery , Copenhagen University Hospital , Herlev , Denmark., Danmark
  • Anne Tjønneland, Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark., Danmark

OBJECTIVE: To investigate long-term pattern of mortality in menopausal women according to different modalities of hormone therapy.

DESIGN: Population based prospective cohort study.

SETTING: Denmark 1993-2013.

POPULATION: 29,243 women aged 50-64 years at entry into the Diet, Cancer, and Health Cohort, enrolled 1993-1997 and followed through December 31, 2013.

METHODS: Cox' proportional hazards models for increasingly longer periods of follow up time were used to estimate mortality pattern according to baseline hormone use adjusted for relevant potential confounders.

MAIN OUTCOME: All cause and cause specific mortality. Outcome information was obtained from the Danish Causes of Death Registry (linkage 99.6%).

RESULTS: 4,098 women died during a median follow-up of 17.6 years. After adjustment for relevant lifestyle risk factors, hormone use had no impact on all-cause mortality, regardless of modality. Among baseline users lower CVD mortality was only evident after 5 years (HR 0.54; 95% CI: 0.32-0.92), but dissipated with additional follow-up. Reversely, lower colorectal cancer mortality (HR 0.64; 95% CI 0.46-0.89), and higher breast cancer mortality (HR 1.34; 95% CI 1.05-1.72) only became evident after 15 years follow-up. There were no significant associations for mortality from other types of cancer or from stroke.

CONCLUSIONS: In this long-term follow-up study, taking hormones during menopause was not associated with overall mortality among middle-aged women. Investigating cause-specific mortality revealed significant albeit weak associations differential according to both causes of death and over time underlining the importance of carefully considering individual risks and duration of treatment when making decisions on hormone therapy. This article is protected by copyright. All rights reserved.

TidsskriftB J O G
Sider (fra-til)55-63
Antal sider9
StatusUdgivet - 1 jan. 2019

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