A study carried out on 800,000 women takes stock of the risk of death from cancer or cardiovascular diseases in particular, associated with hormonal treatments for menopause.
Taking medication to stop the unpleasant symptoms of menopause but perhaps exposing yourself to a risk of breast cancer or cardiovascular accidents: this is the problem that thousands of women are exposed to after the age of 50. For good reason, since an American study in 2002, hormonal treatments for menopause remain surrounded by suspicion.
The debate has been going on for more than twenty years. Long accused of increasing the risks of breast cancer or cardiovascular diseases, hormonal treatments for menopause (THM) continue to give rise to caution. These treatments aim to compensate for the drop in estrogen associated with menopause, often combined with progestins, in order to relieve symptoms that are sometimes very debilitating: hot flashes, night sweats, sleep problems or irritability. A new large-scale study changes the situation. Published on February 19 in the medical journal BMJ, this research carried out in Denmark is based on health data from nearly 800,000 women born between 1950 and 1977. Among them, around 100,000 used hormonal treatment to relieve symptoms linked to menopause.
Result: the researchers did not find “no epidemiological evidence of excess mortality” in women who have taken THM. In other words, these treatments are not associated with an increased risk of death. The highly publicized American study in 2002 pointed to an increased risk of breast cancer and cardiovascular diseases in women taking hormonal treatment, leading to a significant drop in prescriptions, in France as in the United States. Since then, several studies have qualified these conclusions, in particular because the participants in the initial study were older than the women who usually start treatment. The new Danish analysis, carried out on an entire generation and followed for around ten years, reinforces these reassessments.
The authors believe that their results support current international recommendations, in particular those of the Endocrine Society, which recommends the use of THMs in women at the start of menopause presenting moderate to severe symptoms, in the absence of contraindications, particularly cardiovascular. The study, however, provides a nuance: if the treatments do not increase mortality, they do not seem to reduce it significantly either. An exception appears in women who have undergone removal of both ovaries, often carried out to prevent cancer in patients at risk. In this specific group, taking hormonal treatment is associated with a reduction of about a third in the risk of death.
These data do not mean that hormonal treatments are without risks. Their prescription remains a personalized medical decision, based on age, cardiovascular profile and intensity of symptoms. But they provide a clear message: used within the framework of current recommendations, THMs do not appear to increase mortality.
