Summary of findings for the main comparison. Combined continuous hormone therapy (HT) compared with placebo for postmenopausal women.
| Combined continuous hormone therapy (HT) compared with placebo for perimenopausal and postmenopausal women | ||||||
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Population: relatively healthy postmenopausal women Setting: community Intervention: combined continuous HT (moderate‐dose oestrogen) ‐ CEE 0.625 mg + MPA 2.5 mg Comparison: placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk* | Corresponding risk | |||||
| Placebo | Combined continuous hormone therapy (HT) | |||||
|
Coronary events (MI or cardiac death) Follow‐up: mean/median 1 year |
2 per 1000 | 4 per 1000 (3 to 7) | RR 1.89 (1.15 to 3.10) | 20,993 (2 studies) | ⊕⊕⊕⊝ Moderatea | |
| Stroke Follow‐up: mean 3 years | 6 per 1000 | 8 per 1000 (6 to 12) | RR 146 (1.02 to 2.09) | 17,585 (2 studies) | ⊕⊕⊕⊝ Moderatea | |
|
Venous thromboembolism (DVT or PE) Follow‐up: mean/median 1 year |
2 per 1000 | 7 per 1000 (4 to 11) | RR 4.28 (2.49 to 7.34) | 20,993 (2 studies) | ⊕⊕⊕⊝ Moderatea | |
| Breast cancer Follow‐up: median 5.6 years | 19 per 1000 | 24 per 1000 (20 to 30) | RR 1.27 (1.03 to 1.56) | 16,608 (1 study) | ⊕⊕⊕⊝ Moderatea | |
|
Death from lung cancer Follow‐up: median 8 yearsb |
5 per 1,000 |
9 per 1000 (6 to 13) |
RR 1.74 (1.18 to 2.55) |
16,608 (1 study) | ⊕⊕⊕⊝ Moderatea | |
|
Gallbladder disease Follow‐up: mean 5.6 years |
16 per 1000 | 27 per 1000 (21 to 34) |
RR 1.64 (1.30 to 2.06) |
14,203 (1 study) |
⊕⊕⊕⊝ Moderatea | |
| All clinical fractures Follow‐up: mean 5.6 years | 111 per 1000 | 87 per 1000 (79 to 96) | RR 0.78 (0.71 to 0.86) | 16,608 (1 study) | ⊕⊕⊕⊝ Moderatea | |
| *The basis for the assumed risk is the mean risk in the control group. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aDowngraded one level for questionable applicability: Only about 33% of the study sample was 50‐59 years of age at baseline (i.e. the age women are most likely to consider HT for vasomotor symptoms); mean participant age was 63 years.
b5.6 years' intervention plus postintervention follow‐up: post hoc analysis.