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Background: The association between use of menopausal hormone therapy and risk of cutaneous melanoma is highly debated. We investigated the issue in a Finnish nationwide cohort of women ages 50 years or older. Methods: All women who had purchased hormone therapy between 1994 and 2007 were identified from the national Medical Reimbursement Registry and linked to the Finnish Cancer Registry. We calculated standardized incidence ratios (SIR) to compare incidence of cutaneous melanoma among hormone therapy users with that of the general population. Results: During a mean follow-up of 15.6 years, 1,695 incident cutaneous melanoma cases were identified among 293,570 women who had used hormone therapy for at least 6 months. The SIRs for women who used unopposed estrogen therapy and combined estrogen-progestin therapy (EPT) for 6 to 59 months were 1.20 [95% confidence interval (CI), 1.06-1.35] and 1.00 (95% CI, 0.87-1.14; Pheterogeneity = 0.04). The SIRs for women who used estrogen therapy and EPT for at least 60 months were 1.37 (95% CI, 1.22-1.52) and 1.23 (95% CI, 1.13-1.34; Pheterogeneity = 0.15). We did not find significant differences between oral and transdermal administrations, nor between doses of estrogens. Conclusions: Use of hormone therapy, especially estrogen therapy, was associated with an increased risk of cutaneous melanoma. EPT use of less than 5 years was not associated with an increased risk of cutaneous melanoma. [ABSTRACT FROM AUTHOR]

Objective The Women's Health Initiative (WHI) study clarified the indications and contraindications for postmenopausal hormone therapy (HT). We studied the impact of the WHI results on the risk of fatal stroke in HT users in Finland. Study design Retrospective analysis setting : Nationwide registers on postmenopausal HT use and causes of death between 1995 and 2009. Population Women ≥40 years ( n = 290,272) using systemic estradiol-based postmenopausal HT. Methods Follow-up started from the first HT purchase during the pre-WHI era (1995–2001) and post-WHI era (2002–2009). Main outcome measures Stroke deaths in HT users were compared with that in the age-matched background population and expressed as standardized mortality ratio (SMR) with 95% confidence intervals. Results Overall, 311 HT users died due to stroke. The exposure to HT ≤1 year was associated with a similarly reduced 22% (0.67–0.91) risk of stroke death in the pre-WHI era and in the post-WHI era 27% (0.55–0.94). The risk reductions for HT exposure of 1–8 years in the pre-WHI era (47%, 0.42–0.65) did not differ from that in the post-WHI era (32%, 0.48–0.94). The discontinuation of HT was accompanied by a significant 33% (1.02–1.72) increase in stroke death risk in the pre-WHI era and a non-significant 32% (0.84–1.99) increase in the post-WHI era within the first post-treatment year, but no longer after 1–8 years. Conclusions The change in prescribing policy after the WHI study did not affect the risk of fatal stroke in Finnish HT users. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to estimate the risk of endometrial cancer in all Finnish postmenopausal women with the use of various forms of estradiol-progestin therapy. The study identified 224,015 women who used estradiol-progestin therapy from 1994-2006. A total of 1,364 incidence of endometrial cancer in therapy users was compared with the general population. It reveals that the use of a continuous estradiol-progestin regimen decreases the risk of endometrial cancer.

The article offers information on the risk of breast cancer in women undergoing progestogen therapy, using estradiol. A study was conducted among Finnish women using postmenopausal estradiol. The result of the study revealed that the use of estradiol in progestogen therapy has increased the risk for breast cancer.

The article discusses a study of Finnish women aged above 50 years which evaluated whether the risk of estrogen-only therapy on breast cancer varies by dose, constituent, and route of administration. It notes two to three extra cases of breast cancer per 1,000 women for orally or transdermally administered estradiol for five years or more. No risks of breast cancer were associated with oral estradiol use for less than five years, oral estradiol, or vaginal estrogens.

Objectives: The role of postmenopausal hormone therapy (HT) in the incidence of acute coronary syndrome (ACS) has been studied extensively, but less is known of the impact of HT on the mortality risk due to an ACS.Study Design and Main Outcome Measures: We extracted from a population-based ACS register, FINAMI, 7258 postmenopausal women with the first ACS. These data were combined with HT use data from the National Drug Reimbursement Register; 625 patients (9%) had used various HT regimens. The death risks due to ACS before admission to hospital, 2-28, or 29-365days after the incident ACS were compared between HT users and non-users with logistic regression analyses.Results: In all follow-up time points, the ACS death risks in HT ever-users were smaller compared to non-users. Of women with HT ever use, 42% died within one year as compared with 52% of non-users (OR 0.62, p<0.001). Most deaths (84%) occurred within 28days after the ACS, and in this group 36% of women with ever use of HT (OR 0.73, p=0.002) and 30% of women with ≥5year HT use (OR 0.54, p<0.001) died as compared to 43% of the non-users. Age ≤60 or >60 years at the HT initiation was accompanied with similar reductions in ACS mortality risk.Conclusions: Postmenopausal HT use is accompanied with reduced mortality risk after primary ACS. [ABSTRACT FROM AUTHOR]

Context: Current guidelines recommend annual discontinuation of postmenopausal hormone therapy (HT) to evaluate whether a woman could manage without the treatment. The impact of HT on cardiovascular health has been widely studied, but it is not known how the withdrawal of HT affects cardiovascular risk., Objective: We evaluated the risk of cardiac or stroke death after the discontinuation of HT. Design, Patients, Interventions, and Main Outcome Measures: Altogether 332 202 Finnish women discontinuing HT between 1994 and 2009 (data from National Reimbursement register) were followed up from the discontinuation date to death due to cardiac cause (n = 3177) or stroke (n = 1952), or to the end of 2009. The deaths, retrieved from the national Cause of Death Register, were compared with the expected number of deaths in the age-standardized background population. In a subanalysis we also compared HT stoppers with HT users., Results: Within the first posttreatment year, the risk of cardiac death was significantly elevated (standardized mortality ratio; 95% confidence interval 1.26; 1.16-1.37), whereas follow-up for longer than 1 year was accompanied with a reduction (0.75; 0.72-0.78). The risk of stroke death in the first posttreatment year was increased (1.63; 1.47-1.79), but follow-up for longer than 1 year was accompanied with a reduced risk (0.89; 0.85-0.94). The cardiac (2.30; 2.12-2.50) and stroke (2.52; 2.28-2.77) death risk elevations were even higher when compared with HT users. In women who discontinued HT at age younger than 60 years, but not in women aged 60 years or older, the cardiac mortality risk was elevated (1.94; 1.51-2.48)., Conclusions: Increased cardiovascular death risks question the safety of annual HT discontinuation practice to evaluate whether a woman could manage without HT.

Objective: Data on the health benefits and risks of postmenopausal hormone therapy (HT) are derived mainly from the use of conjugated equine estrogens. Estradiol-based regimens may have a different risk-benefit profile. We evaluated the risk of death caused by coronary heart disease (CHD), stroke, or any disease among users of estradiol-based HT regimens in a nationwide study in Finland., Methods: A total of 489,105 women who used HT from 1994 to 2009 (3.3 million HT exposure years), as indicated in the nationwide reimbursement register and the national Cause of Death Register, were followed. A total of 28,734 HT users died during follow-up; among the deaths, 3,843 were caused by CHD and 2,464 were caused by stroke. Mortality risk in HT users with varying duration of exposure (≤1 y, >1 to 3 y, >3 to 5 y, >5 to 10 y, or >10 y) was compared with that in an age-matched background population., Results: Risk of CHD death was significantly reduced by 18% to 54% in HT users and was positively related to HT exposure time. Risk of stroke death was also reduced by 18% to 39%, but this reduction was not clearly related to HT exposure time. Risk of all-cause mortality was reduced in HT users by 12% to 38%, almost in linear relationship with duration of exposure. All these risk reductions were comparable in women initiating HT before age 60 years and women initiating HT at age 60 years or older., Conclusions: In absolute terms, the risk reductions mean 19 fewer CHD deaths and 7 fewer stroke deaths per 1,000 women using any HT for at least 10 years.

Hormone therapy is the most effective treatment for sweating and hot flashes, which are the most common symptoms of the menopause. The initiation of therapy for a healthy female of 50 to 59 years usually entails more health benefits than adverse effects, and there is no absolute upper limit for the duration of the treatment. It remains to be evaluated yearly whether the need or prerequisites for continuation of the treatment still exist. If the use of hormone therapy is not desired, alleviation of hot flashes and sweating can be attempted with life style modifications and other remedies.

Breast cancer is a heterogenous disease and hormonal factors are involved. Since national differences exist in the use of postmenopausal hormone therapy (HT) and other risk factors, associations between HT and breast cancer should be studied nationally. In Finland, estrogen-progestin therapy is associated with higher breast cancer risk than estrogen-only therapy. Also tibolone and levonorgestrel releasing intauterine device combined with estrogen are accompanied with an increased risk of breast cancer. Hormone therapy possibly promotes the growth of the existing undetectable cancer.