Variation in use of menopausal hormone treatment on risk of health outcomes

Table 1 Distribution of outcomes and variation of use of menopausal hormone therapy in study cohort

	No. of women
	Never-users		Ever-users
No. of events during 14 yr follow-up (% in group)
Coronary artery disease	33	(11.5%)	29	(14.3%)
Stroke	23	(8.0%)	19	(9.4%)
Peripheral arteria disease	10	(3.5%)	19	(9.4%)
Breast cancer	20	(6.9%)	12	(5.9%)
Timing of initiation of therapy from onset of menopause
“Early start” ( ≤ 3 yr)	-		162	(80.2%)
“Late start” (> 3 yr)	-		40	(19.8%)
Type of regimen
Oestrogen-only	-		30	(14.8%)
Oestrogen + progestogen	-		168	(83.2%)
Tibolone	-		4
Combination of treatment strategy
Early start plus oestrogen-only	-		20	(9.9%)
Early start plus oestrogen + progestogen	-		140	(69.3%)
Late start plus oestrogen-only	-		10	(4.9%)
Late start plus oestrogen + progestogen	-		28	(13.9%)
Other			4
Age of patient when treatment started
20-39 yr	-		17	(8.4%)
40-49 yr	-		85	(42.0%)
50-59 yr	-		82	(40.6%)
60-69 yr	-		18	(8.9%)
70-79 yr	-		17	(8.4%)
Age of patient when treatment stopped
20-39 yr	-		0
40-49 yr	-		20	(9.9%)
50-59 yr	-		85	(42.1%)
60-69 yr	-		69	(34.1%)
70-79 yr	-		28	(13.9%)
Duration of use (yr)
< 1	-		15	(7.4%)
1-5	-		67	(33.2%)
6-10	-		37	(18.3%)
11-15	-		45	(22.3%)
16-20	-		19	(9.4%)
21-25	-		11	(5.4%)
> 25	-		7	(3.4%)
Total No. of women	287		202

Table 2 Menopausal hormone treatment and risk of serious outcomes: Ever-use, timing of initiation of treatment and type of regimen

	Relative risk estimate (95%Cl)
	Coronaryartery disease	Stroke	Peripheralartery disease	Breastcancer
Ever-use	1.29 (0.76, 2.20)	1.14 (0.61, 2.14)	2.16 (0.99, 4.71)	0.84 (0.40, 1.76)
	P = 0.35	P = 0.69	P = 0.051	P = 0.65
Timing of initiation from onset of menopause
Early start	1.02 (0.56, 1.86)	1.04 (0.52, 2.06)	1.65 (0.69, 3.94)	0.97 (0.45, 2.08)
	P = 0.94	P = 0.92	P = 0.26	P = 0.94
Late start	2.57 (1.15, 5.72)	1.57 (0.56, 4.37)	4.42 (1.55, 12.64)	0.34 (0.05, 2.37)
	P = 0.021	P = 0.39	P = 0.0052	P = 0.28
Type of regimen
Oestrogen only	2.34 (0.93, 5.88)	0.78 (0.18, 3.49)	5.01 (1.62, 15.48)	2.05 (0.65, 6.46)
	P = 0.07	P = 0.75	P = 0.005	P = 0.22
Oestrogen + progestogen	1.16 (0.65, 2.06)	1.23 (0.64, 2.37)	1.59 (0.67, 3.79)	0.67 (0.29, 1.55)
	P = 0.62	P = 0.53	P = 0.30	P = 0.35
Combination of treatment strategy
Early start plus oestrogen-only	2.57 (0.88, 7.52)	1.22 (0.27, 5.56)	1.32 (0.16, 10.78)	2.36 (0.64, 8.72)
	P = 0.09	P = 0.80	P = 0.80	P = 0.20
Early start plus oestrogen + progestogen	0.86 (0.44, 1.66)	1.03 (0.50, 2.12)	1.72 (0.70, 4.26)	0.81 (0.35, 1.89)
	P = 0.65	P = 0.94	P = 0.24	P = 0.62
Late start plus oestrogen-only	1.92 (0.39, 9.45)	NC	16.73 (4.12, 67.91)	1.48 (0.18, 12.29)
	P = 0.42		P < 0.0012	P = 0.71
Late start plus oestrogen + progestogen	3.08 (1.26, 7.55)	2.38 (0.83, 6.83)	0.93 (0.12, 7.46)	NC
	P = 0.011	P = 0.11	P = 0.94

NC: No convergence due to small numbers. By multivariate analysis adjusting for age at recruitment, body mass index, smoking, physical activity and alcohol use, co-morbidities (diabetes mellitus, hypertension, hypercholesterolaemia) shows:

¹P 0.05 – 0.01;

²P < 0.01.

Table 3 Variation of use of menopausal hormone treatment and risk of serious outcomes : Age of patient and duration of use

	Relative risk estimate (95%Cl)
	Coronaryartery disease	Stroke	Peripheral artery disease	Breast cancer
Age of patient when treatment started (yr)
20-39	0.48 (0.07, 3.35)	0.68 (0.09, 5.35)	1.57 (0.19, 12.79)	0.83 (0.11, 6.57)
	P = 0.47	P = 0.72	P = 0.67	P = 0.87
40-49	1.14 (0.55, 2.37)	0.98 (0.41, 2.37)	2.25 (0.85, 5.96)	0.66 (0.22, 1.97)
	P = 0.72	P = 0.97	P = 0.10	P = 0.45
50-59	0.83 (0.37, 1.87)	1.18 (0.51, 2.75)	1.63 (0.55, 4.79)	0.87 (0.32, 2.38)
	P = 0.65	P = 0.69	P = 0.37	P = 0.78
60-79	7.7 (2.85, 20.76)	2.19 (0.59, 8.11)	5.01 (1.27, 19.80)	1.67 (0.36, 7.77)
	P < 0.001	P = 0.24	P = 0.02	P = 0.52
Age of patient when treatment stopped (yr)
20-39	1.36 (0.38, 4.88)	1.22 (0.27, 5.56)	2.79 (0.57, 13.53)	1.48 (0.32, 6.85)
	P = 0.64	P = 0.80	P = 0.20	P = 0.61
40-49	0.48 (0.18, 1.27)	0.54 (0.18, 1.59)	0.92 (0.25, 3.37)	0.32 (0.97, 1.41)
	P = 0.50	P = 0.26	P = 0.90	P = 0.13
50-59	1.3 (0.61, 2.80)	1.24 (0.51, 3.00)	2.83 (1.06, 7.60)	1.75 (0.74, 4.16)
	P = 0.50	P = 0.64	P = 0.04	P = 0.20
60-79	4.98 (2.19, 11.55)	2.99 (1.11, 8.08)	4.18 (1.24, 14.14)	NC
	P < 0.001	P = 0.03	P = 0.02
Duration of use (yr)
< 1	1.1 (0.24, 5.04)	NC	3.59 (0.72, 17.75)	1.91 (0.40, 8.98)
	P = 0.90		P = 0.12	P = 0.41
1-5	0.76 (0.31, 1.87)	1.28 (0.53, 3.11)	1.18 (0.32, 4.34)	0.85 (0.28, 2.57)
	P = 0.55	P = 0.59	P = 0.81	P = 0.77
6-10	2.12 (0.90, 5.03)	0.3 (0.04, 2.32)	1.43 (0.31, 6.74)	0.37 (0.40, 2.85)
	P = 0.09	P = 0.25	P = 0.65	P = 0.34
11-15	0.75 (0.26, 2.20)	1.69 (0.65, 4.38)	3.14 (1.04, 9.50)	0.95 (0.27, 3.35)
	P = 0.60	P = 0.28	P = 0.04	P = 0.94
16-20	2.75 (0.93, 8.11)	1.29 (0.28, 5.92)	NC	0.74 (0.09, 5.84)
	P = 0.07	P = 0.74		P = 0.78
21-25	2.89 (0.73, 11.41)	2.44 (0.50, 11.92)	5.57 (1.07, 28.92)	1.33 (0.16, 10.96)
	P = 0.13	P = 0.27	P = 0.04	P = 0.79
26+	1.28 (0.15, 10.97)	1.83 (0.21, 15.80)	10.03 (1.75, 57.58)	NC
	P = 0.82	P = 0.58	P = 0.01

NC: No convergence due to small numbers.