Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Peri- and post-menopausal women up to 65 years
Intervention: HRT
Comparison: No HRT
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Breast cancer ᵃ | No statistically significant difference | Very Low |
Breast cancer (oestrogen plus progesterone) | See note ᵇ | See note ᵇ |
Breast cancer (oestrogen only) | No statistically significant difference | Low |
Breast cancer (oestrogen plus progesterone versus oestrogen only) | No statistically significant difference | Very Low |
Randomised controlled trials with post-intervention follow-up ᶜ | ||
Breast cancer (current HRT user, 10-year follow-up) ᵃ | No statistically significant difference | Very Low |
Breast cancer (oestrogen plus progesterone, 8.2 years post-intervention follow-up) | Favours comparison | Low |
Breast cancer (oestrogen, 6.6 years post-intervention follow-up) | No statistically significant difference | Low |
Breast cancer (oestrogen, 10.6 years post-intervention follow-up) | No statistically significant difference | Very Low |
Recommendations as stated in the source guideline The results in this table are underpinned by randomised controlled trial (RCT) evidence but the recommendations made by the guideline development group also take into account observational cohort evidence included in the guideline, stating that women around the age of natural menopause should be advised of the following: The baseline risk of breast cancer for women around menopausal age varies from one woman to another according to the presence of underlying risk factors HRT with an oestrogen alone is associated with little or no change in the risk of breast cancer HRT with an oestrogen and a progestogen can be associated with an increase in the risk of breast cancer Any increase in the risk of breast cancer is related to treatment duration and reduces after stopping HRT. Following surveillance for new evidence, this guideline is in the process of being updated. In the interim, NICE have added the MHRA risk table and recommend referring to this during discussions with women about HRT (https://assets.publishing.service.gov.uk/media/5d680409e5274a1711fbe65a/Table1.pdf).
Note ᵃ Results for this outcome are included in one RCT which evaluates HRT (estradiol and estradiol plus norethisterone for women with uterus; estradiol only for women without uterus) versus no treatment. ᵇ Results are presented in two RCTs separately with low and very low quality evidence reporting no statistically significant difference between treatment groups. ᶜ The guideline development group notes that the duration of HRT treatment ranged from 11.9 months to 14 years. They also note that post-intervention follow-up was reported in some trials ranging from 8 to 10 years which did not necessarily account for the full length of time participants were exposed to HRT, given that some women had previously used HRT.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the benefits and harms of long-term estrogen-only hormone replacement therapy for healthy postmenopausal women?
- What are the benefits and harms of long-term combined hormone replacement therapy for healthy postmenopausal women?
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