Long-term hormone therapy after hysterectomy yields benefits up to 20 years

Key takeaways:

• Menopausal symptoms were significantly lower after hormone therapy vs. 20 years prior.
• Hormone therapy was associated with decreases in LDL cholesterol and increases in T-score vertebral densitometry.

Hormone therapy with transdermal estradiol may benefit bone and CV health and overall quality of life up to 20 years after hysterectomy, according to study results published in Menopause.

“The main finding is the change in the duration of hormone therapy,” Marta Cuadros Celorrio, PhD, principal researcher at the Biosanitary Research Institute of Granada and professor in the department of biochemistry, molecular biology and immunology at the University of Granada, told Healio. “Until now, hormone therapy was only prescribed in specific cases, such as women with early menopause or those with a lot of severe symptoms, and hormone therapy was not maintained longer than 5 years.”

Cuadros Celorrio and colleagues conducted a prospective, observational, longitudinal study with 259 women who underwent hysterectomy and received transdermal estradiol with the dose reduced by half at age 60 years. Researchers analyzed demographics, CV metrics, bone density, metabolic variables and quality of life characteristics. Menopause symptoms were measured by the Kupperman index with higher scores equaling more severe symptoms.

Overall, 56 women completed 20 years of hormone therapy follow-up. Of the 203 postmenopausal women who discontinued hormone therapy during prospective follow-up, 95 cited misinformation as the main reason, and four women dropped out due to breast cancer.

After 20 years of hormone therapy, mean Kupperman index scores for menopausal symptoms — including hot flashes, insomnia, mood changes, muscle pain, joint and back pain, vaginal dryness and urologic symptoms — decreased from a mean score of 26.7 at baseline to 12 (P < .001). Researchers observed a trend with total and LDL cholesterol reduction and HDL cholesterol increase over time.

In addition, researchers noted a decrease in the mean VLDL cholesterol (P = .05) and an increase in the mean T-score vertebral densitometry (P = .014) from baseline after hormone therapy.

There were no changes in health outcomes among women older than 60 years with the reduced hormone therapy dose.

“We need to promote research in the health of middle-aged women, who are largely forgotten by the health system. The main obstacle is that menopause symptoms are usually normalized, being assumed as a physiological process within the course of a woman’s life. Thus, it is necessary to understand the physical, psychological and social changes in this stage of their life of transition to menopause and also during menopause,” Cuadros Celorrio said. “Furthermore, more and better health resources are required. We need to improve the education of doctors who still today continue to remember the results of the Women’s Health Initiative study.”

For more information:

Marta Cuadros Celorrio, PhD, can be reached at mcuadros@ugr.es.