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Risks and benefits of menopausal hormone therapy in postmenopausal Chinese women

Su, Irene H. MD, MSCE1; Chen, Yu-Chun MD, PhD2; Hwang, Wei-Ting PhD3; Liu, Ziyue PhD3; Su, Tung-Ping MD2; Chen, Tzeng-Ji MD3; Barnhart, Kurt T. MD, MSCE3; Yang, Yu-Xiao MD, MSCE3

doi: 10.1097/gme.0b013e31824362ff
Original Articles

Objective: The aim of this study was to assess risks and benefits of conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA) in postmenopausal Chinese women.

Methods: A retrospective cohort study was undertaken using the Taiwan National Health Insurance Research Database, a population-based healthcare claims dataset. Eligible women aged 50 to 79 years were classified as exposed to CEE 0.625 mg/day with MPA 5.0 mg/day (estrogen [E] + progestin [P], n = 4,712) or CEE 0.625 mg/day only (E-only, n = 1,208) and were age-matched to unexposed women (n = 10,125). Follow-up was complete in 96% of the participants. The primary outcomes were coronary heart disease (CHD) and invasive breast cancer. The global index summarized risks of primary outcomes, stroke, pulmonary embolism, colon and endometrial cancers, hip fractures, and death. Time-to-event analyses were performed.

Results: Median durations of exposure in the E + P and E-only groups were 6.9 and 9 months, respectively. Median follow-up was 110 months. Hazard ratios (95% CI) for E + P exposure were as follows: myocardial infarction, 0.78 (0.51-1.19); CHD death, 1.21 (0.53-2.70); breast cancer, 1.48 (1.20-1.83); global index, 0.79 (0.72-0.87). Hazard ratios for E-only exposure were as follows: myocardial infarction, 0.76 (0.35-1.68); CHD death, 0.57 (0.11-2.80); breast cancer, 1.44 (0.99-2.10); global index, 1.09 (0.92-1.28). Per 10,000 person-years, there were 12 excess breast cancer cases with E + P exposure; there were 39 fewer global index events with E + P exposure. Adjusting for age, statin and aspirin use, hypercholesterolemia, diabetes, and hypertension did not significantly change estimates.

Conclusions: In postmenopausal Chinese women, CEE with or without MPA was not associated with increased rates of CHD, but CEE with MPA may be associated with a higher breast cancer rate. E + P exposure conferred lower global index event rates.

From the 1University of California, San Diego, Department of Reproductive Medicine, La Jolla, CA; 2National Yang-Ming University, Taipei, Taiwan; and 3University of Pennsylvania, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA.

Received September 8, 2011; revised and accepted November 17, 2011.

Drs. Su and Chen contributed equally to this work.

Funding/support: ASRM/Ortho Research Grant in Reproductive Medicine (I.H.S.), HD-058799 (I.H.S.), ACS MRSG-08-110-01-CCE (I.H.S.), K24HD060687 (K.T.B.). Sponsors had no role in the design, analysis or presentation of this research.

Financial disclosure/conflicts of interest: None reported.

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Address correspondence to: Irene H. Su, MD, MSCE, 3855 Health Sciences Drive, #0901, La Jolla, CA 92093-0901. E-mail:

©2012The North American Menopause Society