Hormone replacement therapy prescribing in menopausal women in the UK: a descriptive study

Alsugeir, Dana; Li, Wei; Adesuyan, Matthew; Cook, Sarah; Panay, Nicholas; Brauer, Ruth

doi:10.3399/bjgpo.2022.0126

Cited by 12 publications

(7 citation statements)

References 23 publications

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“…Such inconsistencies in WHI guidelines may explain the regained acceptance of HT, with a steady increase in the number of women receiving their first prescription for HT. 28 The present study also possesses several limitations to consider in future research. We did not compare with a control group without HT, which is a reason for further study.…”

Section: Discussionmentioning

confidence: 89%

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Benefits for cardiovascular system, bone density, and quality of life of a long-term hormone therapy in hysterectomized women: a 20-year follow-up study

Lorite,

Cuadros,

Rivera-Izquierdo

et al. 2023

Menopause

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Objective The safety, consequences, and dosage of long-term hormone therapy (HT) for postmenopausal women remain unclear. Our aim was to analyze the effects of HT after 20 years of therapy in women after hysterectomy, focusing on the symptoms of menopause, blood pressure, lipid profiles, and bone density. Methods A prospective observational longitudinal study was designed. The initial transdermal estradiol dose was reduced in half (0.025 mg/d) at 60 years of age. Different parameters including demographic, cardiovascular, bone density, and metabolic variables, as well as quality of life characteristics, were analyzed using bivariate analyses. Multivariate generalized estimating equations for longitudinal data were fitted for differences over time and between doses (<60 vs ≥60 y) using the R package geepack. Results After 20 years of HT, the mean age of 56 studied hysterectomized women was 67.1 years. The mean Kupperman index score decreased from 26.7 to 12.0 (P < 0.001). A trend with total and low-density lipoprotein cholesterol reduction and high-density lipoprotein cholesterol increase was observed over time. A decrease in very-low-density lipoprotein cholesterol (P = 0.05) and an increase in T score vertebral densitometry (P = 0.014) were detected after HT. No changes in health outcome were detected in women older than 60 years with the reduced dose of HT. Breast cancer was the reason for dropouts in 0.02% women. Conclusions HT for up to 20 years after hysterectomy may be beneficial for bone and cardiovascular health and for the overall quality of life. Our data suggest the importance of evaluating the dose and the timing of HT.

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Section: Discussionmentioning

confidence: 89%

“…Furthermore, WHI results did not evaluate the mortality or the causal link between HT and breast cancer. Such inconsistencies in WHI guidelines may explain the regained acceptance of HT, with a steady increase in the number of women receiving their first prescription for HT 28 …”

Section: Discussionmentioning

confidence: 99%

Benefits for cardiovascular system, bone density, and quality of life of a long-term hormone therapy in hysterectomized women: a 20-year follow-up study

Lorite,

Cuadros,

Rivera-Izquierdo

et al. 2023

Menopause

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“…These changes in the incidence trend likely reflect a reduced effect of the initial incidence increases brought about by mammography screening in the UK introduced from the late 1980s or a possible effect of a decline in usage of hormone replacement treatment. 27 28 However, the effect of hormone replacement treatment on breast cancer risk is small in comparison to other risk factors, 7 and trends in this treatment has varied over time, such as changes in preferred formulations, doses, and treatment durations, 29 30 31 which may impact breast cancer risk levels. 32 33 As has been reported elsewhere, 34 35 36 mortality for breast cancer has declined substantially despite the incidence increase, which is indicative of improvements in early detection (including through screening 37 ) and improved treatment.…”

Section: Discussionmentioning

confidence: 99%

25 year trends in cancer incidence and mortality among adults aged 35-69 years in the UK, 1993-2018: retrospective secondary analysis

Shelton,

Zotow,

Smith

et al. 2024

BMJ

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Objective To examine and interpret trends in UK cancer incidence and mortality for all cancers combined and for the most common cancer sites in adults aged 35-69 years. Design Retrospective secondary data analysis. Data sources Cancer registration data, cancer mortality and national population data from the Office for National Statistics, Public Health Wales, Public Health Scotland, Northern Ireland Cancer Registry, NHS England, and the General Register Office for Northern Ireland. Setting 23 cancer sites were included in the analysis in the UK. Participants Men and women aged 35-69 years diagnosed with or who died from cancer between 1993 to 2018. Main outcome measures Change in cancer incidence and mortality age standardised rates over time. Results The number of cancer cases in this age range rose by 57% for men (from 55 014 cases registered in 1993 to 86 297 in 2018) and by 48% for women (60 187 to 88 970) with age standardised rates showing average annual increases of 0.8% in both sexes. The increase in incidence was predominantly driven by increases in prostate (male) and breast (female) cancers. Without these two sites, all cancer trends in age standardised incidence rates were relatively stable. Trends for a small number of less common cancers showed concerning increases in incidence rates, for example, in melanoma skin, liver, oral, and kidney cancers. The number of cancer deaths decreased over the 25 year period, by 20% in men (from 32 878 to 26 322) and 17% in women (28 516 to 23 719); age standardised mortality rates reduced for all cancers combined by 37% in men (−2.0% per year) and 33% in women (−1.6% per year). The largest decreases in mortality were noted for stomach, mesothelioma, and bladder cancers in men and stomach and cervical cancers and non-Hodgkin lymphoma in women. Most incidence and mortality changes were statistically significant even when the size of change was relatively small. Conclusions Cancer mortality had a substantial reduction during the past 25 years in both men and women aged 35-69 years. This decline is likely a reflection of the successes in cancer prevention (eg, smoking prevention policies and cessation programmes), earlier detection (eg, screening programmes) and improved diagnostic tests, and more effective treatment. By contrast, increased prevalence of non-smoking risk factors are the likely cause of the observed increased incidence for a small number of specific cancers. This analysis also provides a benchmark for the following decade, which will include the impact of covid-19 on cancer incidence and outcomes.

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“…In addition, a small study reported that women receiving DHA supplementation had lower increases in EPA and higher DHA:EPA ratios if they were taking oral HRT compared to those not on HRT, suggesting reduced retroconversion of DHA to EPA (128) . Increasingly, periand postmenopausal women are now being prescribed transdermal oestrogen (rather than oral) (129) , due to its efficacy in resolving menopausal symptoms and a superior safety profile. Transdermal oestrogen treatments are applied at much lower doses and are metabolised differently to oral treatments, avoiding first-pass hepatic metabolism to pass directly into the bloodstream.…”

Section: Causes Of Differential Cvd Risks Throughout the Female Life ...mentioning

confidence: 99%

Long chain n-3 polyunsaturated fatty acid intake across the life span for cardiovascular disease prevention in women

Hall

2024

Proc. Nutr. Soc.

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Cardiovascular diseases (CVD) are a major health concern for women. Historically there has been a misconception that men are at greater risk, because CVD tends to occur earlier in life compared to women. Clinical guidelines for prevention of heart disease are currently the same for both sexes, but accumulating evidence demonstrates that risk profiles diverge. In fact, several CVD risk factors confer an even greater risk in women relative to men, including high blood pressure, obesity, diabetes and raised triglycerides. Furthermore, many female-specific CVD risk factors exist, including early menarche, pregnancy complications, polycystic ovary syndrome, reproductive hormonal treatments, and menopause. Little is known about how diet interacts with CVD risk factors at various stages of a woman’s life. Long chain (LC) n-3 polyunsaturated fatty acid (PUFA) intakes are a key dietary factor that may impact risk of CVD throughout the life course differentially in men and women. Oestrogen enhances conversion of the plant n-3 PUFA, alpha-linolenic acid, to LCn-3 PUFA. Increasing the frequency of oily fish consumption or LCn-3 PUFA supplementation may be important for reducing coronary risk during the menopausal transition, during which time oestrogen levels decline and the increase in CVD risk factors is accelerated. Women are under-represented in the evidence base for CVD prevention following LC n-3 PUFA supplementation. Therefore it is not clear whether there are sex differences in response to treatment. Furthermore, there is a lack of evidence on optimal intakes of LC n-3 PUFA across the lifespan for CVD prevention in women.

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Hormone replacement therapy prescribing in menopausal women in the UK: a descriptive study

Cited by 12 publications

References 23 publications

Benefits for cardiovascular system, bone density, and quality of life of a long-term hormone therapy in hysterectomized women: a 20-year follow-up study

Benefits for cardiovascular system, bone density, and quality of life of a long-term hormone therapy in hysterectomized women: a 20-year follow-up study

25 year trends in cancer incidence and mortality among adults aged 35-69 years in the UK, 1993-2018: retrospective secondary analysis

Long chain n-3 polyunsaturated fatty acid intake across the life span for cardiovascular disease prevention in women

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