Benefits for cardiovascular system, bone density, and quality of life of a long-term hormone therapy in hysterectomized women: a 20-year follow-up study

Abstract

Objective: The safety, consequences, and dosage of long-term hormone therapy (HT) for postmenopausal women remain unclear. Our aim was to analyze the effects of HT after 20 years of therapy in women after hysterectomy, focusing on the symptoms of menopause, blood pressure, lipid profiles, and bone density.

Methods: A prospective observational longitudinal study was designed. The initial transdermal estradiol dose was reduced in half (0.025 mg/d) at 60 years of age. Different parameters including demographic, cardiovascular, bone density, and metabolic variables, as well as quality of life characteristics, were analyzed using bivariate analyses. Multivariate generalized estimating equations for longitudinal data were fitted for differences over time and between doses (<60 vs ≥60 y) using the R package geepack.

Results: After 20 years of HT, the mean age of 56 studied hysterectomized women was 67.1 years. The mean Kupperman index score decreased from 26.7 to 12.0 ( P < 0.001). A trend with total and low-density lipoprotein cholesterol reduction and high-density lipoprotein cholesterol increase was observed over time. A decrease in very-low-density lipoprotein cholesterol ( P = 0.05) and an increase in T score vertebral densitometry ( P = 0.014) were detected after HT. No changes in health outcome were detected in women older than 60 years with the reduced dose of HT. Breast cancer was the reason for dropouts in 0.02% women.

Conclusions: HT for up to 20 years after hysterectomy may be beneficial for bone and cardiovascular health and for the overall quality of life. Our data suggest the importance of evaluating the dose and the timing of HT.

FIG. 1

Flow chart of selection process of hysterectomized women with HT for 20 years and dropouts. After the first medical visit, women were followed annually for 20 years in the menopause medical unit. HT, hormone therapy.

FIG. 2

Graphical analysis of multivariate GEE models of each outcome variable ((A) Kupperman index; (B) LDL cholesterol; (C) total cholesterol; (D) VLDL cholesterol; (E) HDL cholesterol; and (F) T score) adjusted for time (visit) and age. The tendencies are shown separately for women younger than 60 years and older than 60 years, respectively, according to differences in therapy doses. Visits 0, 1, 2, 3, and 4 correspond to initial visit, visit at 5 years, 10 years, 15 years, and 20 years respectively. GEE, generalized estimating equations; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; VLDL, very-low-density lipoprotein cholesterol.