The influence of menopausal hormone therapy on somatic morbidity in postmenopausal women

Abstract

Menopausal hormone therapy (MHT) which is initiated in women less than 60 years old or within 10 years after the onset of menopause for the relief of menopausal symptoms, treatment of urogenital syndrome or osteoporosis, is currently the only way to reduce the risk of developing cardiovascular diseases, thrombotic and metabolic disorders in healthy middle-aged women. This article presents the results of evaluating the use of hormone therapy in women during the menopausal transition to the state of somatic health in postmenopause by determining its effect on the state of the cardiovascular and bone systems, changes in the lipid profile, as well as on the risk of thrombosis in the postmenopause period.The objective: to determine the effect of MHT on somatic morbidity in postmenopausal women.Materials and methods. An analysis of the anamnesis, anthropometric indicators, results of general clinical and biochemical data of 120 women of menopausal age, who were divided depending on the use of menopausal hormone therapy into a study group (patients used MHT, n=60) and a control group (patients did not use MHT, n=60), is presented.All women were observed on the basis of the communal non-profit enterprise “Kyiv Perinatal Center” in the period from 2013 to 2023. Results. There was no significant difference in the indicators of the metabolic profile (levels of lipid fractions and glucose), as well as in anthropometric parameters (systolic and diastolic blood pressure, body mass index) between women of both groups (p>0.05). The risk of cardiovascular events (especially angina pectoris, hypertension) was higher in women of the control group who did not use hormonal drugs (related risk (RR) 0.5 with a 95% confidence interval (CI) from 0.28 to 0.91; p<0.007). However, it was found that there were significant differences between the groups in bone mineral density (the frequency of women with osteopenia was 43.3% in the control group versus 35% in the study group, and osteoporosis was diagnosed in 15% of women in the group without MHT versus 5% of women from the study group; RR is 0.69 with 95% CI≥0.5 at the confidence level p=0.05) and parameters affecting the risk of thrombotic complications (platelet level was 239.4±28.4×109/l in the control group versus 295.6±28.2×109/l in the study group, p<0.001; the level of fibrinogen was 7.7±1.2 mmol/l in women without MHT versus 8.7±2.0 mmol/l in women with MHT, p=0.001; prothrombin time was 13.2±1.3 sec in the control group versus 15.0±1.1 sec in the study group, p<0.001).Conclusions. Menopausal hormone therapy (MHT) is an effective method of preventing the development of osteopenic and osteoporotic conditions in women during the perimenopause period, but it also reliably significantly affects certain indicators of blood coagulation properties – the level of platelets, fibrinogen and prothrombin time – in the direction of their increase. It was established that the use of hormone replacement therapy the risks of developing adverse cardiovascular events (especially arterial hypertension and angina pectoris) are reduced, but, given the lack of difference between the compared groups of women in indicators of lipid metabolism, glucose, as well as in anthropometric data (which are the main risk factors for the development of cardiovascular diseases), further research is needed to establish the relationships of these parameters in more detail.During the appointment of MHT, one should be guided by the results of an individual risk/benefit assessment for the patient, paying special attention to the study of her anamnestic data.