Increased Cardiovascular Mortality Risk in Women Discontinuing Postmenopausal Hormone Therapy

Mikkola, Tomi S.; Tuomikoski, Pauliina; Lyytinen, Heli; Korhonen, Pasi; Hoti, Fabian; Vattulainen, Pia; Gissler, Mika; Ylikorkala, Olavi

doi:10.1210/jc.2015-1864

Cited by 91 publications

(42 citation statements)

References 40 publications

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“…In addition, review of a Finnish registry that accounts for types of MHT other than oCEE, confirmed decreases in mortality from coronary artery disease and stroke in women using MHT for longer than 10 years and an increase in mortality in women who discontinue use [36,37]. Additional studies need to confirm these observations in other ethnic populations of women.…”

Section: Clinical Studies Of Sex Hormonesmentioning

confidence: 99%

Sex hormone therapy and progression of cardiovascular disease in menopausal women

et al. 2016

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One of the most controversial health decisions facing women is deciding upon the use of hormonal treatments for symptoms of menopause. This brief review focuses on the historical context of use of menopausal hormone treatments (MHT), summarizes results of major observational, primary and secondary prevention studies of MHT and cardiovascular (CV) outcomes, provides evidence for how sex steroids modulate CV function and identifies challenges for future research. As medicine enters an era of personalization of treatment options, additional research into sex differences in the aetiology of CV diseases will lead to better risk identification for CV disease in women and identify whether a woman might receive CV benefit from specific formulations and doses of MHT.

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Section: Clinical Studies Of Sex Hormonesmentioning

confidence: 99%

Sex hormone therapy and progression of cardiovascular disease in menopausal women

et al. 2016

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“…These surges have been associated with vasomotor instability, coronary spasm, myocardial infarction, and mortality. (15, 32,33)…”

Section: Cardiovascularmentioning

confidence: 99%

“…For example, Mikkola et al reported increased cardiovascular mortality in the year immediately following hormone therapy withdrawal with 25% of the deaths occurring in the first month. (33) The Finnish group related these findings to surges of epinephrine which occurred after hormone withdrawal. (33)…”

Section: Mortalitymentioning

confidence: 99%

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Hormone replacement therapy in young women with surgical primary ovarian insufficiency

Sarrel

Sullivan

Nelson

2016

Fertility and Sterility

104

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Bilateral oophorectomy performed in women before they are menopausal induces surgical primary ovarian insufficiency (Surgical POI), an acute and chronic deficiency of the hormones normally produced by the ovaries. Without hormone replacement therapy most of these women develop severe symptoms of estrogen deficiency and are at increased risk for osteoporosis, cardiovascular disease, cognitive decline, dementia, and the associated increases in morbidity and mortality. In cases in which a hysterectomy has been performed at the time of bilateral oophorectomy transdermal or transvaginal estradiol replacement therapy without cyclic progestin replacement is the optimum hormonal management for these women. There is substantial evidence this approach even reduces the risk for breast cancer. Unfortunately, unwarranted fear of all menopausal hormone therapies has become widespread following the reports of the Women's Health Initiative studies. This fear has led to a steep decline in use of estrogen therapy even in women in whom hormone replacement therapy is clearly indicated. Discussion of possible ovarian conservation in women who are premenopausal is an integral part of the preoperative planning for any women undergoing hysterectomy. Timely and effective hormone replacement therapy for women who will experience Surgical POI is clearly indicated.

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“…It has been estimated that 'the avoidance of estrogen' in newly postmenopausal women (age 50-59 years) following the publication of the WHI in 2002 has led to almost 60 000 excess deaths in women in the US during a 10-year period 97 . Further, evidence from a Finnish population-based, observational study suggests a transient increase in risk of CVD mortality in women who discontinue postmenopausal HT 98 .…”

Section: Menopausal Symptoms and Cvd Riskmentioning

confidence: 99%

Cardiovascular risk assessment in women – an update

et al. 2016

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Cardiovascular disease is the leading cause of morbidity and mortality in postmenopausal women. Although it is a disease of aging, vascular disease initiates much earlier in life. Thus, there is a need to be aware of the potential to prevent the development of the disease from an early age and continue this surveillance throughout life. The menopausal period and early menopause present an ideal opportunity to assess cardiovascular risk and plan accordingly. Generally in this period, women will be seen by primary health-care professionals and non-cardiovascular specialists. This review addresses female-specific risk factors that may contribute to the potential development of cardiovascular disease. It is important for all health-care professionals dealing with women in midlife and beyond to be cognisant of these risk factors and to initiate female-specific preventative measures or to refer to a cardiovascular specialist.

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Increased Cardiovascular Mortality Risk in Women Discontinuing Postmenopausal Hormone Therapy

Abstract: Increased cardiovascular death risks question the safety of annual HT discontinuation practice to evaluate whether a woman could manage without HT.

Cited by 91 publications

References 40 publications

Sex hormone therapy and progression of cardiovascular disease in menopausal women

Sex hormone therapy and progression of cardiovascular disease in menopausal women

Hormone replacement therapy in young women with surgical primary ovarian insufficiency

Cardiovascular risk assessment in women – an update

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