Timing and duration of menopausal hormone treatment may affect cardiovascular outcomes

S. Mitchell Harman, Eric Vittinghoff, Eliot A. Brinton, Matthew J. Budoff, Marcelle I. Cedars, Rogerio A. Lobo, George R. Merriam, Virginia M Miller, Frederick Naftolin, Lubna Pal, Nanette Santoro, Hugh S. Taylor, Dennis M. Black

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Largely on the basis of the first publication of findings of net harm with menopausal hormone treatment in the Women's Health Initiative (WHI) hormone trials, current Food and Drug Administration recommendations limit menopausal hormone treatment to the "... shortest duration consistent with treatment goals ...," with goals generally taken to mean relief of menopausal symptoms and maximal duration as approximately 5 years. The WHI finding of net harm was due largely to the absence of beneficial effects on coronary heart disease incidence rates. Published analyses of WHI data by age or time since menopause find that excess coronary heart disease risk with menopausal hormone treatment is confined to more remotely menopausal or older women, with younger women showing nonsignificant trends toward benefit (the "timing hypothesis"). Moreover, a recently published reexamination of data from the WHI Estrogen plus Progestin trial suggests that reduced coronary heart disease risk may appear only after 5 to 6 years of treatment. Consistent with this finding, risk ratios for coronary heart disease were calculated as 1.08 (95% confidence interval, 0.86-1.36) in years 1 to 6 and as 0.46 (confidence interval, 0.28-0.78) in years 7 to 8+ in the WHI Estrogen Alone trial. Previous studies also support the beneficial effects of menopausal hormone treatment after prolonged exposure. Thus, current analyses do not support a generalized recommendation for short duration of menopausal hormone treatment. Rather, they suggest that current Food and Drug Administration practice guidelines should be reconsidered to allow individualized care based on risk:benefit considerations. New research is urgently needed evaluating influences of timing, duration, dose, route of administration, and agents on menopausal hormone treatment-related risks and benefits to better understand how to optimize recommendations for individual patients.

Original languageEnglish (US)
Pages (from-to)199-205
Number of pages7
JournalAmerican Journal of Medicine
Volume124
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Hormones
Women's Health
Coronary Disease
United States Food and Drug Administration
Therapeutics
Estrogens
Confidence Intervals
Progestins
Menopause
Practice Guidelines
Publications
Odds Ratio
Incidence
Research

Keywords

  • Cardiovascular disease
  • Estrogen
  • Hormones
  • Menopause
  • Women's health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Harman, S. M., Vittinghoff, E., Brinton, E. A., Budoff, M. J., Cedars, M. I., Lobo, R. A., ... Black, D. M. (2011). Timing and duration of menopausal hormone treatment may affect cardiovascular outcomes. American Journal of Medicine, 124(3), 199-205. https://doi.org/10.1016/j.amjmed.2010.09.021

Timing and duration of menopausal hormone treatment may affect cardiovascular outcomes. / Harman, S. Mitchell; Vittinghoff, Eric; Brinton, Eliot A.; Budoff, Matthew J.; Cedars, Marcelle I.; Lobo, Rogerio A.; Merriam, George R.; Miller, Virginia M; Naftolin, Frederick; Pal, Lubna; Santoro, Nanette; Taylor, Hugh S.; Black, Dennis M.

In: American Journal of Medicine, Vol. 124, No. 3, 03.2011, p. 199-205.

Research output: Contribution to journalArticle

Harman, SM, Vittinghoff, E, Brinton, EA, Budoff, MJ, Cedars, MI, Lobo, RA, Merriam, GR, Miller, VM, Naftolin, F, Pal, L, Santoro, N, Taylor, HS & Black, DM 2011, 'Timing and duration of menopausal hormone treatment may affect cardiovascular outcomes', American Journal of Medicine, vol. 124, no. 3, pp. 199-205. https://doi.org/10.1016/j.amjmed.2010.09.021
Harman, S. Mitchell ; Vittinghoff, Eric ; Brinton, Eliot A. ; Budoff, Matthew J. ; Cedars, Marcelle I. ; Lobo, Rogerio A. ; Merriam, George R. ; Miller, Virginia M ; Naftolin, Frederick ; Pal, Lubna ; Santoro, Nanette ; Taylor, Hugh S. ; Black, Dennis M. / Timing and duration of menopausal hormone treatment may affect cardiovascular outcomes. In: American Journal of Medicine. 2011 ; Vol. 124, No. 3. pp. 199-205.
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