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Menopausal Hormone Therapy and Risk of Endometrial Cancer: A Systematic Review

Background: Menopausal hormone therapy (MHT) is an appropriate treatment for women with the climacteric syndrome. The estrogen component of MHT effectively alleviates climacteric symptoms but also stimulates the endometrium and thus may increase the risk of endometrial cancer (EC). Materials and Met...

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Autores principales: Tempfer, Clemens B., Hilal, Ziad, Kern, Peter, Juhasz-Boess, Ingolf, Rezniczek, Günther A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465414/
https://www.ncbi.nlm.nih.gov/pubmed/32781573
http://dx.doi.org/10.3390/cancers12082195
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author Tempfer, Clemens B.
Hilal, Ziad
Kern, Peter
Juhasz-Boess, Ingolf
Rezniczek, Günther A.
author_facet Tempfer, Clemens B.
Hilal, Ziad
Kern, Peter
Juhasz-Boess, Ingolf
Rezniczek, Günther A.
author_sort Tempfer, Clemens B.
collection PubMed
description Background: Menopausal hormone therapy (MHT) is an appropriate treatment for women with the climacteric syndrome. The estrogen component of MHT effectively alleviates climacteric symptoms but also stimulates the endometrium and thus may increase the risk of endometrial cancer (EC). Materials and Methods: We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify controlled and uncontrolled clinical trials reporting on the prevalence and/or incidence of EC among women using MHT. Results: 31 publications reporting on 21,306 women with EC diagnosed during or after MHT were identified. A significantly reduced risk of EC among continuous-combined (cc)MHT users with synthetic progestins (SPs) was demonstrated in 10/19 studies with odds ratios (ORs)/hazard ratios (HRs) between 0.24 and 0.71. Only one study documented an increased risk of EC among long-term users (≥10 years), not confirmed in three other sub-group analyses of women with ≥6, ≥5, and >10 years of ccMHT use. A significantly increased risk of EC among users of sequential-combined (sc)MHT with SPs was demonstrated in 6/12 studies with ORs/HRs between 1.38 and 4.35. Number of days of progestin per month was a significant modulator of EC risk. A decreased risk of EC was seen in obese women. Two studies documented an increased risk of EC among users of cc/scMHT with micronized progesterone. A significantly increased risk of EC among estrogen-only MHT users was demonstrated in 9/12 studies with ORs/HRs between 1.45 and 4.46. The adverse effect of estrogen-only MHT was greatest among obese women. Conclusion: ccMHT with SPs reduces the risk of EC, whereas estrogen-only MHT increases the risk. scMHT with SPs and cc/scMHT with micronized progesterone increase the risk of EC depending on type of progestin, progestin dosage, and duration of MHT use.
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spelling pubmed-74654142020-09-04 Menopausal Hormone Therapy and Risk of Endometrial Cancer: A Systematic Review Tempfer, Clemens B. Hilal, Ziad Kern, Peter Juhasz-Boess, Ingolf Rezniczek, Günther A. Cancers (Basel) Review Background: Menopausal hormone therapy (MHT) is an appropriate treatment for women with the climacteric syndrome. The estrogen component of MHT effectively alleviates climacteric symptoms but also stimulates the endometrium and thus may increase the risk of endometrial cancer (EC). Materials and Methods: We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify controlled and uncontrolled clinical trials reporting on the prevalence and/or incidence of EC among women using MHT. Results: 31 publications reporting on 21,306 women with EC diagnosed during or after MHT were identified. A significantly reduced risk of EC among continuous-combined (cc)MHT users with synthetic progestins (SPs) was demonstrated in 10/19 studies with odds ratios (ORs)/hazard ratios (HRs) between 0.24 and 0.71. Only one study documented an increased risk of EC among long-term users (≥10 years), not confirmed in three other sub-group analyses of women with ≥6, ≥5, and >10 years of ccMHT use. A significantly increased risk of EC among users of sequential-combined (sc)MHT with SPs was demonstrated in 6/12 studies with ORs/HRs between 1.38 and 4.35. Number of days of progestin per month was a significant modulator of EC risk. A decreased risk of EC was seen in obese women. Two studies documented an increased risk of EC among users of cc/scMHT with micronized progesterone. A significantly increased risk of EC among estrogen-only MHT users was demonstrated in 9/12 studies with ORs/HRs between 1.45 and 4.46. The adverse effect of estrogen-only MHT was greatest among obese women. Conclusion: ccMHT with SPs reduces the risk of EC, whereas estrogen-only MHT increases the risk. scMHT with SPs and cc/scMHT with micronized progesterone increase the risk of EC depending on type of progestin, progestin dosage, and duration of MHT use. MDPI 2020-08-06 /pmc/articles/PMC7465414/ /pubmed/32781573 http://dx.doi.org/10.3390/cancers12082195 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Tempfer, Clemens B.
Hilal, Ziad
Kern, Peter
Juhasz-Boess, Ingolf
Rezniczek, Günther A.
Menopausal Hormone Therapy and Risk of Endometrial Cancer: A Systematic Review
title Menopausal Hormone Therapy and Risk of Endometrial Cancer: A Systematic Review
title_full Menopausal Hormone Therapy and Risk of Endometrial Cancer: A Systematic Review
title_fullStr Menopausal Hormone Therapy and Risk of Endometrial Cancer: A Systematic Review
title_full_unstemmed Menopausal Hormone Therapy and Risk of Endometrial Cancer: A Systematic Review
title_short Menopausal Hormone Therapy and Risk of Endometrial Cancer: A Systematic Review
title_sort menopausal hormone therapy and risk of endometrial cancer: a systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465414/
https://www.ncbi.nlm.nih.gov/pubmed/32781573
http://dx.doi.org/10.3390/cancers12082195
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