What is behind the fear of cancer during menopausal hormone therapy in China?

Wang, Yanfang; Wang, Wei; Feng, Ying; Tan, Zhangyun; Yang, Xiaomin; Peng, Danhong; Zhao, Yongmei; Dong, Han; Zheng, Qinghe; Zeng, Xiaoqin; Zou, Ying; Sun, Aijun

doi:10.1007/s00404-021-06052-4

Cited by 2 publications

(3 citation statements)

References 38 publications

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“…These findings might be related to the fact that dyslipidaemia and cardiovascular health awareness is low among younger women who might have been less compliant to the administered therapy due lack of knowledge or exaggerated fear of treatment side effects, for example, hormone-dependent cancers. 83,84 Interestingly, TG increased predominantly in females younger than 60 years and in those who were not suffering from hypertriglyceridaemia before RCT enrolment. This might be related to the low awareness regarding dyslipidaemia in adults, despite the fact that females seem to be more conscious versus men about this cardiometabolic disorder.…”

Section: Discussionmentioning

confidence: 99%

“…Women aged 60 or elder and those who already suffered from hypercholesterolaemia at the moment of recruitment were more likely to depict reductions in TC and LDL‐C levels and elevations in HDL‐C. These findings might be related to the fact that dyslipidaemia and cardiovascular health awareness is low among younger women who might have been less compliant to the administered therapy due to lack of knowledge or exaggerated fear of treatment side effects, for example, hormone‐dependent cancers 83,84 . Interestingly, TG increased predominantly in females younger than 60 years and in those who were not suffering from hypertriglyceridaemia before RCT enrolment.…”

Section: Discussionmentioning

confidence: 99%

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Comprehensive meta‐analysis of the effects of oral medroxyprogesterone acetate plus conjugated equine oestrogens on the lipid profile in women: Insights from randomized controlled trials

Zhang,

Xie,

et al. 2024

Eur J Clin Investigation

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BackgroundMenopause is associated with elevated cardiovascular risk due to the loss of the cardioprotective effect of oestrogens. Postmenopausal women are often prescribed hormone replacement therapy (HRT) in order to control menopause symptoms and correct hormone imbalances; however, HRT can impact serum lipids' concentrations. At present, data on the effect of the administration of medroxyprogesterone acetate plus conjugated equine oestrogens (MPACEE) on the lipid profile in females are uncertain, as the investigations conducted so far have produced conflicting results. Thus, we aimed to clarify the impact of MPACEE prescription on the serum lipids' values in women by means of a systematic review and meta‐analysis of randomized controlled trials (RCTs).MethodsWe employed a random‐effects model based on the DerSimonian and Laird method to determine the combined estimates of the intervention's impact on the lipid profile. The computation of the weighted mean difference (WMD) and its corresponding 95% confidence interval (CI) relied on the mean and standard deviation values from both the MPACEE and control group, respectively.ResultsA total of 53 RCTs were included in the meta‐analysis with 68 RCT arms on total cholesterol (TC), 70 RCT arms on low‐density lipoprotein cholesterol (LDL‐C) and triglycerides (TG), and 69 RCT arms on high‐density lipoprotein cholesterol (HDL‐C). Administration of MPACEE resulted in a significant reduction of TC (WMD = −11.93 mg/dL; 95% CI: −13.42, −10.44; p < .001) and LDL‐C (WMD = −16.61 mg/dL; 95% CI: −17.97, −15.26; p < .001) levels, and a notable increase in HDL‐C (WMD = 3.40 mg/dL; 95% CI: 2.93, 3.86; p < .001) and TG (WMD = 10.28 mg/dL; 95% CI: 7.92, 12.64; p < .001) concentrations. Subgroup analysis revealed that changes in the lipid profile were influenced by several factors: body mass index (for TC, HDL‐C, TG), MPACEE dosages (for TC, LDL‐C, HDL‐C, TG), age (for TC, LDL‐C, HDL‐C, TG), durations of the intervention (for TC, LDL‐C, HDL‐C, TG), continuous/sequential administration of MPACEE (continuous for TC; sequential for LDL‐C, TG) administration of MPACEE and serum lipids' concentrations before enrolment in the RCT (for TC, LDL‐C, HDL‐C, TG).ConclusionsMPACEE administration can influence serum lipids' concentrations in females by raising HDL‐C and TG levels and reducing LDL‐C and TC values. Therefore, postmenopausal women who suffer from hypercholesterolaemia might benefit from this type of HRT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comprehensive meta‐analysis of the effects of oral medroxyprogesterone acetate plus conjugated equine oestrogens on the lipid profile in women: Insights from randomized controlled trials

Zhang,

Xie,

et al. 2024

Eur J Clin Investigation

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“…Nonetheless, the findings of the included studies are not able to exclude a different risk. Therefore, further investigation is needed to clarify whether the transdermal route carries a lower risk or not [ 80 ]. In this regard, other administration routes, such as topical vaginal estrogen preparations, seemed to lead to lower risk, further reducing the systemic exposure [ 53 , 81 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of transdermal versus oral hormone replacement therapy in postmenopause: a systematic review

Goldštajn

Mikuš

Ferrari

et al. 2022

Arch Gynecol Obstet

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Purpose To summarize available evidence comparing the transdermal and the oral administration routes of hormone replacement therapy (HRT) in postmenopausal women. Methods We performed a systematic review of the literature on multiple databases between January 1990 and December 2021. We included randomized controlled trials and observational studies comparing the transdermal and oral administration routes of estrogens for HRT in postmenopausal women regarding at least one of the outcomes of interest: cardiovascular risk, venous thromboembolism (VTE), lipid metabolism, carbohydrate metabolism, bone mineral density (BMD), and risk of pre-malignant and malignant endometrial lesions, or breast cancer. Results The systematic literature search identified a total of 1369 manuscripts, of which 51 were included. Most studies were observational and of good quality, whereas the majority of randomized controlled trials presented a high or medium risk of bias. Oral and transdermal administration routes are similar regarding BMD, glucose metabolism, and lipid profile improvements, as well as do not appear different regarding breast cancer, endometrial disease, and cardiovascular risk. Identified literature provides clear evidence only for the VTE risk, which is higher with the oral administration route. Conclusions Available evidence comparing the transdermal and oral administration routes for HRT is limited and of low quality, recommending further investigations. VTE risk can be considered the clearest and strongest clinical difference between the two administration routes, supporting the transdermal HRT as safer than the oral administration route.

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What is behind the fear of cancer during menopausal hormone therapy in China?

Cited by 2 publications

References 38 publications

Comprehensive meta‐analysis of the effects of oral medroxyprogesterone acetate plus conjugated equine oestrogens on the lipid profile in women: Insights from randomized controlled trials

Comprehensive meta‐analysis of the effects of oral medroxyprogesterone acetate plus conjugated equine oestrogens on the lipid profile in women: Insights from randomized controlled trials

Effects of transdermal versus oral hormone replacement therapy in postmenopause: a systematic review

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