Hormone replacement therapy and the risk of endometrial cancer: A systematic review
Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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Hormone replacement therapy and the risk of endometrial cancer : A systematic review. / Sjögren, Lea L; Mørch, Lina Steinrud; Løkkegaard, Ellen.
I: Maturitas, Bind 91, 09.2016, s. 25-35.Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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TY - JOUR
T1 - Hormone replacement therapy and the risk of endometrial cancer
T2 - A systematic review
AU - Sjögren, Lea L
AU - Mørch, Lina Steinrud
AU - Løkkegaard, Ellen
N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
PY - 2016/9
Y1 - 2016/9
N2 - BACKGROUND: In 1975, estrogen only was found to be associated with an increased risk of endometrial cancer. In November 2015, NICE guidelines on hormone therapy were published that did not take this risk into account.AIM: This systematic literature review assesses the safety of estrogen plus progestin therapy according to the risk of endometrial cancer, while considering both regimen and type of progestin.METHODS: PubMed, EMBASE and the Cochrane Library were searched, resulting in the identification of 527 published articles on menopausal women with intact uteri treated with estrogen only, estrogen plus progestin or tibolone for a minimum of one year. Risk of endometrial cancer was compared to placebo or never users and measured as relative risk, hazard or odds ratio.RESULTS: 28 studies were included. The observational literature found an increased risk among users of estrogen alone. Continuous combined therapy showed a lower risk than sequential combined therapy. The newer marketed micronized progesterone increased the risk notably, also when administered continuously. In most studies, tibolone was associated with an increased risk.CONCLUSION: Use of unopposed estrogen, tibolone and sequential combined therapy increases the risk of endometrial cancer. Continuous combined therapy seems risk free, but possibly not when micronized progesterone is used.
AB - BACKGROUND: In 1975, estrogen only was found to be associated with an increased risk of endometrial cancer. In November 2015, NICE guidelines on hormone therapy were published that did not take this risk into account.AIM: This systematic literature review assesses the safety of estrogen plus progestin therapy according to the risk of endometrial cancer, while considering both regimen and type of progestin.METHODS: PubMed, EMBASE and the Cochrane Library were searched, resulting in the identification of 527 published articles on menopausal women with intact uteri treated with estrogen only, estrogen plus progestin or tibolone for a minimum of one year. Risk of endometrial cancer was compared to placebo or never users and measured as relative risk, hazard or odds ratio.RESULTS: 28 studies were included. The observational literature found an increased risk among users of estrogen alone. Continuous combined therapy showed a lower risk than sequential combined therapy. The newer marketed micronized progesterone increased the risk notably, also when administered continuously. In most studies, tibolone was associated with an increased risk.CONCLUSION: Use of unopposed estrogen, tibolone and sequential combined therapy increases the risk of endometrial cancer. Continuous combined therapy seems risk free, but possibly not when micronized progesterone is used.
KW - Endometrial Neoplasms
KW - Estrogen Replacement Therapy
KW - Estrogens
KW - Female
KW - Humans
KW - Middle Aged
KW - Odds Ratio
KW - Postmenopause
KW - Practice Guidelines as Topic
KW - Progestins
KW - Risk Factors
KW - Journal Article
KW - Review
U2 - 10.1016/j.maturitas.2016.05.013
DO - 10.1016/j.maturitas.2016.05.013
M3 - Review
C2 - 27451318
VL - 91
SP - 25
EP - 35
JO - Maturitas
JF - Maturitas
SN - 0378-5122
ER -
ID: 177062959