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Menopausal hormone therapy and women's health: an umbrella review. [Dataset]

Contributors

Guo-Qiang Zhang
Data Collector

Jin-Liang Chen
Data Collector

Ying Luo
Data Collector

Maya B. Mathur
Data Collector

Panagiotis Anagnostis
Data Collector

Ulugbek Nurmatov
Data Collector

Madar Talibov
Data Collector

Jing Zhang
Data Collector

Catherine M. Hawrylowicz
Data Collector

Mary Ann Lumsden
Data Collector

Hilary Critchley
Data Collector

Aziz Sheikh
Data Collector

Bo Lundbäck
Data Collector

Cecilia Lässer
Data Collector

Hannu Kankaanranta
Data Collector

Bright I. Nwaru
Data Collector

Abstract

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. The authors conducted an umbrella review to comprehensively summarize evidence on the benefits and harms of MHT across diverse health outcomes. 60 published systematic reviews of MHT use in menopausal women, involving 102 meta-analyses of randomized controlled trials and 38 of observational studies, and synthesized the evidence on 102 health outcomes were selected. Overall, MHT had a complex balance of benefits and harms; for example, beyond alleviation of menopausal symptoms, it was associated with decreased risks of bone fracture, diabetes mellitus, and esophageal, gastric, and colorectal cancer, but increased risks of stroke, venous thromboembolism, gallbladder disease, and breast and ovarian cancer. The available clinical data in support of MHT reducing the risk of coronary heart disease and all-cause mortality in women aged

Citation

ZHANG, G.-Q., CHEN, J.-L., LUO, Y., et al. 2021. Menopausal hormone therapy and women's health: an umbrella review. [Dataset]. PLoS medicine [online], 18(8), article e1003731. Available from: https://doi.org/10.1371/journal.pmed.1003731#sec034

Acceptance Date Jul 12, 2021
Online Publication Date Aug 2, 2021
Publication Date Dec 31, 2021
Deposit Date Aug 17, 2021
Publicly Available Date Aug 17, 2021
Publisher Public Library of Science
DOI https://doi.org/10.1371/journal.pmed.1003731
Keywords Estrogen; Menopausal hormone therapy; Meta-analysis; Progestin; Umbrella review
Public URL https://rgu-repository.worktribe.com/output/1400329
Related Public URLs https://rgu-repository.worktribe.com/output/1289821
Type of Data XLSX files, PDF files, DOCX, R file and accompanying TXT file.
Collection Date Jun 7, 2021
Collection Method MEDLINE, EMBASE, and 10 other databases were searched 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. The term MHT was used 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 < 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).