Hormone Replacement Therapy and its Long-term Impact on the Survival of Women in the United Kingdom

Akter, Nurunnahar (2022) Hormone Replacement Therapy and its Long-term Impact on the Survival of Women in the United Kingdom. Doctoral thesis, University of East Anglia.

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Hormone replacement therapy (HRT) is an effective treatment for relieving symptoms of menopause. However, because of some adverse health consequences, including an increased risk of breast cancer, many symptomatic women are cautious about using HRT. Untreated menopausal symptoms may deteriorate quality of life, increase the risk of developing other health problems, and place additional pressure on the healthcare system. Past studies were mostly based on survey or register data, whereas data from routine primary care may provide greater insights about the effects of HRT in the general population. While previous studies mainly investigated the impact of HRT on morbidities, all-cause mortality may summarise the net benefits and risks.

This study investigated the long-term hazards of all-cause mortality associated with estrogen-only and combined (combination of estrogen and progesterone) HRT using a large electronic primary care records from The Health Improvement Network database. 105,199 HRT users who started the treatment at ages 46 to 65 and 224,643 matched non-users were selected for survival modelling. The hazards of all-cause mortality associated with HRT were estimated
by a newly developed Weibull-Double-Cox model adjusting for important medical, lifestyle, and socio-demographic factors. Multilevel multiple imputation techniques were used to deal with missing data.

The length of study follow-up was up to 32 years (1984-2017), with an average follow-up per participants was almost 14 years. During study follow-up, a total of 21,751 women died, of whom 6,329 were HRT users, and 15,422 non-users. This research found that estrogen only HRT has no long-term impact on mortality at any age, but combined HRT reduces the hazards of death from all-causes. Furthermore, starting combined HRT between the ages of 51 to 55
reduces the hazards of mortality the most. The findings of this study may help women in making an informed choice, and further educating the clinicians and resource planners.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Science > School of Computing Sciences
Depositing User: Chris White
Date Deposited: 20 Mar 2023 11:17
Last Modified: 20 Mar 2023 11:17
URI: https://ueaeprints.uea.ac.uk/id/eprint/91577


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