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The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984−2017
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  • Nurunnahar Akter,
  • Elena Kulinskaya,
  • Nicholas Steel,
  • Ilyas Bakbergenuly
Nurunnahar Akter
University of East Anglia
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Elena Kulinskaya
University of East Anglia
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Nicholas Steel
University of East Anglia
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Ilyas Bakbergenuly
University of East Anglia
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Abstract

Objective: To estimate the effect of hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in women aged 46 to 65 at first prescription. Design: Matched cohort study. Setting: Electronic primary care records from The Health Improvement Network (THIN) database, UK (1984−2017). Population: 105,199 cases and 224,643 controls matched on age and general practice (GP). Methods: Parametric Weibull-Cox regression model adjusted for age at first treatment, type of HRT, birth year, type 2 diabetes, hypertension and its treatments, coronary heart disease, oophorectomy/hysterectomy, body mass index, smoking, and deprivation status. Main outcome measures: All-cause mortality. Results: The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95%CI 0.88−0.94), and in oestrogen-only users was 0.99 (0.93−1.07), respectively, compared to non-users. Age-specific adjusted HRs for all-cause mortality in groups aged 46-50, 51-55, 56-60, and 61-65 years at first treatment were 0.98 (0.92−1.04), 0.87 (0.82−0.92), 0.88 (0.82−0.93), and 0.92 (0.85−0.98), in combined HRT users compared to non-users, and 1.01 (0.84−1.21), 1.03 (0.89−1.18), 0.98 (0.86−1.12), and 0.93 (0.81−1.07) in oestrogen-only users, respectively. Conclusions: Oestrogen-only HRT has no impact on all-cause mortality, but combined HRT reduced the risks. This new information on the long-term risks and benefits of HRT should be used to inform women deciding whether to start or continue with HRT. Funding: IFoA. Keywords: Hormone replacement therapy, menopause, mortality, primary care records. Tweetable abstract: Oestrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.

Peer review status:IN REVISION

19 Jun 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
20 Jun 2021Assigned to Editor
20 Jun 2021Submission Checks Completed
30 Jun 2021Reviewer(s) Assigned
11 Aug 2021Review(s) Completed, Editorial Evaluation Pending
28 Aug 2021Editorial Decision: Revise Major