Hormone replacement therapy
By the Evernow Medical Group Updated November 13, 2020
Annual health outcomes per 10,000 women
Data from the following studies:
- BMJ. 2008; 337: a386
- JAMA. 2013;310(13):1353-1368. doi:10.1001/jama.2013.278042
- JAMA. 2017;318(10):927-938. doi:10.1001/jama.2017.11219
- BMJ 2019;364:k4810
- JAMA. 2020;324(4):369-380. doi:10.1001/jama.2020.9482
Women with uterus taking oral estrogen and progesterone
Women with hysterectomy taking oral estrogen
Invasive breast cancer
Risk increases for women without a hysterectomy and decreases for women with a hysterectomy.
9 additional cases per year per 10,000 women
- Statistically significant
- Population without hysterectomy
- Study group size 16608*
7 fewer cases per year per 10,000 women
- Statistically significant
- Population with hysterectomy
- Study group size 10739*
Diabetes
HRT prevents diabetes while taking therapy.
16 fewer cases per year per 10,000 women
- Statistically significant
- Population without hysterectomy
- Study group size 16608*
21 fewer cases per year per 10,000 women
- Statistically significant
- Population with hysterectomy
- Study group size 10739*
Deaths from Alzheimer’s and dementia
HRT prevents deaths from Alzheimer’s and dementia among women with a hysterectomy, both during and beyond therapy.
The risks were studied but no impact was detected.
- No statistical significance
- Population without hysterectomy
- Study group size 16608*
80 fewer cases per year per 10,000 women
- Statistically significant
- Population with hysterectomy
- Study group size 10739*
All cause mortality
HRT (estrogen) reduces death during therapy for women with a hysterectomy.
The risks were studied but no impact was detected.
- No statistical significance
- Population without hysterectomy
- Study group size 16608*
11 fewer cases per year per 10,000 women
- Statistically significant
- Population with hysterectomy
- Study group size 10739*
Endometrial cancer
HRT (estrogen+progestin) prevents endometrial cancer both during and beyond taking therapy for women without hysterectomy.
3 fewer cases per year per 10,000 women
- Statistically significant
- Population without hysterectomy
- Study group size 16608*
Endometrial cancer is not possible with this population
- There is no data for this population
- Population with hysterectomy
Venous thromboembolism
HRT prevents venous thromboembolism both during and beyond therapy.
3 fewer cases per year per 10,000 women
- Statistically significant
- Population without hysterectomy
- Study group size 1395
- Transdermal HRT
- Age 40-79**
3 fewer cases per year per 10,000 women
- Statistically significant
- Population with hysterectomy
- Study group size 1824
- Transdermal HRT
- Age 55-64**
Coronary heart disease
HRT is not associated with risk of coronary heart disease.
The risks were studied but no impact was detected.
- Not statistically significant
- Population without hysterectomy
- Study group size 16608*
The risks were studied but no impact was detected.
- Not statistically significant
- Population with hysterectomy
- Study group size 10739*
Colorectal cancer
HRT (estrogen+progestin) prevents colorectal cancer during and beyond taking therapy for women without hysterectomy
7 fewer cases per year per 10,000 women
- Statistically significant
- Population without hysterectomy
- Study group size 16608*
The risks were studied but no impact was detected.
- No impact measured
- Population with hysterectomy
- Study group size 10739*
Hip fracture
HRT prevents hip fractures during therapy.
6 fewer cases per year per 10,000 women
- Statistically significant
- Population without hysterectomy
- Study group size 16608*
6 fewer cases per year per 10,000 women
- Statistically significant
- Population with hysterectomy
- Study group size 10739*
Bone fracture
HRT prevents bone fractures during therapy.
51 fewer cases per year per 10,000 women
- Statistically significant
- Population without hysterectomy
- Study group size 16608*
61 fewer cases per year per 10,000 women
- Statistically significant
- Population with hysterectomy
- Study group size 10739*
Gallbladder disease
HRT increases risk of gallbladder disease. Numbers are shown for oral HRT, but the risk is lower with transdermal HRT.**
47 additional cases per year per 10,000 women
- Statistically significant
- Population without hysterectomy
- Study group size 16608*
58 additional cases per year per 10,000 women
- Statistically significant
- Population with hysterectomy
- Study group size 10739*
*The study employed just one route of administration (oral), one formulation of estrogen (conjugated equine estrogens [CEE], 0.625 mg), and only one progestogen (medroxyprogesterone acetate [MPA], 2.5 mg), with limited enrollment of women with bothersome vasomotor symptoms (VMS; hot flashes, night sweats) who were aged younger than 60 years or who were fewer than 10 years from menopause onset—the group of women for whom hormone replacement therapy is primarily indicated.
** A Retrospective study of 80,396 women aged 40-79 with a primary diagnosis of venous thromboembolism (VTE), matched to 391,494 women in the control arm. The study looked for women who had been recently exposed to oral hormone replacement therapy or transdermal hormone replacement therapy to see if there was a significantly increased risk of venous thromboembolism compared with no exposure .