@article { , title = {Menopausal hormone therapy and women’s health: an umbrella review.}, abstract = {Background: There remains uncertainty about the impact of menopausal hormone therapy (MHT) on women’s health. A systematic, comprehensive assessment of the effects on multiple outcomes is lacking. We conducted an umbrella review to comprehensively summarize evidence on the benefits and harms of MHT across diverse health outcomes. Methods and findings: We searched MEDLINE, EMBASE, and 10 other databases from inception to November 26, 2017, updated on December 17, 2020, to identify systematic reviews or meta-analyses of randomized controlled trials (RCTs) and observational studies investigating effects of MHT, including estrogen-alone therapy (ET) and estrogen plus progestin therapy (EPT), in perimenopausal or postmenopausal women in all countries and settings. All health outcomes in previous systematic reviews were included, including menopausal symptoms, surrogate endpoints, biomarkers, various morbidity outcomes, and mortality. Two investigators independently extracted data and assessed methodological quality of systematic reviews using the updated 16-item AMSTAR 2 instrument. Random-effects robust variance estimation was used to combine effect estimates, and 95\% prediction intervals (PIs) were calculated whenever possible. We used the term MHT to encompass ET and EPT, and results are presented for MHT for each outcome, unless otherwise indicated. Sixty systematic reviews were included, involving 102 meta-analyses of RCTs and 38 of observational studies, with 102 unique outcomes. The overall quality of included systematic reviews was moderate to poor. In meta-analyses of RCTs, MHT was beneficial for vasomotor symptoms (frequency: 9 trials, 1,104 women, risk ratio [RR] 0.43, 95\% CI 0.33 to 0.57, p [less than] 0.001; severity: 7 trials, 503 women, RR 0.29, 95\% CI 0.17 to 0.50, p = 0.002) and all fracture (30 trials, 43,188 women, RR 0.72, 95\% CI 0.62 to 0.84, p = 0.002, 95\% PI 0.58 to 0.87), as well as vaginal atrophy (intravaginal ET), sexual function, vertebral and nonvertebral fracture, diabetes mellitus, cardiovascular mortality (ET), and colorectal cancer (EPT), but harmful for stroke (17 trials, 37,272 women, RR 1.17, 95\% CI 1.05 to 1.29, p = 0.027) and venous thromboembolism (23 trials, 42,292 women, RR 1.60, 95\% CI 0.99 to 2.58, p = 0.052, 95\% PI 1.03 to 2.99), as well as cardiovascular disease incidence and recurrence, cerebrovascular disease, nonfatal stroke, deep vein thrombosis, gallbladder disease requiring surgery, and lung cancer mortality (EPT). In meta-analyses of observational studies, MHT was associated with decreased risks of cataract, glioma, and esophageal, gastric, and colorectal cancer, but increased risks of pulmonary embolism, cholelithiasis, asthma, meningioma, and thyroid, breast, and ovarian cancer. ET and EPT had opposite effects for endometrial cancer, endometrial hyperplasia, and Alzheimer disease. The major limitations include the inability to address the varying effects of MHT by type, dose, formulation, duration of use, route of administration, and age of initiation and to take into account the quality of individual studies included in the systematic reviews. The study protocol is publicly available on PROSPERO (CRD42017083412). Conclusions: MHT has a complex balance of benefits and harms on multiple health outcomes. Some effects differ qualitatively between ET and EPT. The quality of available evidence is only moderate to poor.}, doi = {10.1371/journal.pmed.1003731}, eissn = {1549-1676}, issn = {1549-1277}, issue = {8}, journal = {PLoS Medicine}, note = {INFO COMPLETE PERMISSION GRANTED (version = VOR; embargo = none; licence = BY; SHERPA = https://v2.sherpa.ac.uk/id/publication/17597) DOCUMENT READY (VOR downloaded 17/8/2021 LM; Uncorrected proof downloaded to be replaced by VOR when available 5/8/2021 LM) ADDITIONAL INFO - Contact: Siew Hwa Lee}, publicationstatus = {Published}, publisher = {Public Library of Science}, url = {https://rgu-repository.worktribe.com/output/1289821}, volume = {18}, keyword = {Health & Wellbeing, Estrogen, Menopausal hormone therapy, Meta-analysis, Progestin, Umbrella review}, year = {2021}, author = {Zhang, Guo-Qiang and Chen, Jin-Liang and Luo, Ying and Mathur, Maya B. and Anagnostis, Panagiotis and Nurmatov, Ulugbek and Talibov, Madar and Zhang, Jing and Hawrylowicz, Catherine M. and Lumsden, Mary Ann and Critchley, Hilary and Sheikh, Aziz and Lundbäck, Bo and Lässer, Cecilia and Kankaanranta, Hannu and Lee, Siew Hwa and Nwaru, Bright I.} }