Hormone replacement therapy: timing and ovarian status count

Takeaway

• Oestrogen replacement in women with bilateral salpingo-oophorectomy (BSO) and hysterectomy prior to age 60 years may have some benefit.

Why this matters

• Ovarian status and age when beginning hormone replacement therapy may attenuate risks and benefits of hormone replacement therapy in menopausal women.

Key results

• Oestrogen replacement did not improve outcomes in women without BSO:
  • Cumulative follow-up for global index HR, 0.99 (95% CI, 0.90-1.08).
• Women with BSO who received oestrogen prior to the age of 60 years had better long-term outcomes compared with those who received oestrogen after age 70 years:
  • Cumulative follow-up all-cause mortality HR, 0.68 (P=.034).

Study design

• Subgroup analysis of the Women's Health Initiative (WHI).
• Cohort taken from the WHI Estrogen-Alone trial.
• Women aged 50-79 years with hysterectomy and known oophorectomy status were identified (n=9939).
• Participants who received conjugated equine oestrogen (0.625 mg/day) (n=5310) were compared with placebo (n=5429).
• Outcomes included coronary heart disease, breast cancer, stroke, pulmonary embolism, colorectal cancer, and hip fracture.
• Funding: National Heart, Lung, and Blood Institute; National Institutes of Health; and US Department of Health and Human Services; Wyeth Ayerst donated the study drugs.

Limitations

• Timing of oestrogen supplementation varied across participants.