Hormone Replacement Therapy Might Place Some Menopausal Women at Increased Risk of Mortality

Women who experience menopause before the age of 45 might be at an increased risk of all-cause mortality, according to new research, which could be attributed to hormone replacement therapy (HRT) use.

The study findings, published in Preventive Medicine Reports, revealed a 15% increased risk of all-cause mortality among women who experience menopause before age 45.

“Although the mean age at menopause of 51 years has been reported in the United States, some US women experience early menopause resulting in a large population at risk for adverse effects including mortality, with considerable public health impact,” the researchers wrote, adding that after menopause, the risk of coronary heart disease increases.

The researchers collected data from more than 11,000 women participating in the Reasons for Geographic and Racial Differences in Stroke Study enrolled between 2003 and 2007, more than one-third (39%) of whom experienced menopause before age 45.

There were 1524 deaths over a mean follow-up of 7.1 years. The median time to death was 5.2 years among women with early age at menopause and 5.4 years for women without early age at menopause.

Women who reach menopause at an early age had a 31% increased risk of all-cause mortality if they had ever used HRT. Among the women who reported HRT use, there was a 58% increased risk observed among those who were former smokers and a 39% increased risk observed among those who were white.

“While current US guidelines do not recommend routine use of HRT for primary or secondary prevention of heart disease, four indications are FDA-approved including alleviation of vasomotor symptoms (eg, hot flashes and night sweats) and significant genitourinary symptoms after consideration of their cardiovascular health profile, risk of associated adverse events, and the timing of menopause,” the authors noted.

Because several studies have suggested that race/ethnicity and smoking may impact the onset of menopause, the researchers wanted to see if these factors also played a role in risk of mortality menopause. While early age at menopause was associated with a heightened risk of all-cause mortality among white women, the difference was not significant, and there were no differences seen based on smoking status.

Reference

Malek A, Vladutio C, Meyer M, et al. The association of age at menopause and all-cause and specific mortality by race, postmenopausal hormone use, and smoking status [published online July 14, 2019]. Prev Med Rep. doi:10.1016/j.pmedr.2019.100955.