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Combined hormonal contraception
Published in John Guillebaud, Contraception Today, 2019
Even as we turn to unwanted effects, it is reassuring that CHCs have their main (small) effect on every known associated cause of mortality during current use and for some (variable) time thereafter. The excess thrombotic risk has probably vanished by 4 weeks, and by 10 years after use ceases, all-cause mortality and cancer mortality is lower than or (allowing for healthy-user bias) certainly indistinguishable from that in never users.
Combined hormonal contraception
Published in John Guillebaud, Contraception Today, 2016
Even as we turn to unwanted effects, it is reassuring that, based, among other things, on the regular reports of the RCGP study ever since it began in 1968, COCs have their main (small) effect on every known associated cause of mortality during current use and for some (variable) time thereafter. The excess thrombotic risk has probably vanished by 4 weeks, and by 10 years after use ceases, all-cause mortality in past users is lower than or (allowing for healthy-user bias) certainly indistinguishable from that in never users.
Association between menopausal hormone therapy use and mortality risk: a Swedish population-based matched cohort study
Published in Acta Oncologica, 2022
Johanna Simin, Habiba Khodir, Romina Fornes, Rulla M. Tamimi, Nele Brusselaers
Our study has some limitations as well. Whereas the population-based methodology counteracts potential selection bias, we cannot eliminate the possibility of healthy user bias. A link between MHT use, socioeconomic status and potentially better survival and higher adherence to treatment has been described [3,39]. To alleviate these concerns, we stratified the analyses by the different MHT types and current versus past use. Nevertheless, clinicians may be more prone to prescribe MHT to healthier women. The use of menopausal hormones is contraindicated among women at high risk of breast cancer, with current or a history of cardiovascular disease or among women with severe liver disease [23,24]. A closer follow-up is favoured among women using MHT, which could potentially lead to earlier detection of diseases selectively among MHT users. A sensitivity analysis excluding women who died within the first year showed similar results.
Prediagnostic use of estrogen-only therapy is associated with improved colorectal cancer survival in menopausal women: a Swedish population-based cohort study
Published in Acta Oncologica, 2021
Johanna Simin, Qing Liu, Xinchen Wang, Katja Fall, Cecilia Williams, Steven Callens, Lars Engstrand, Nele Brusselaers
This study has also some limitations. Healthy user bias cannot be excluded. Although access to healthcare in Sweden should be equal to all, a link between MHT use, higher socioeconomic status and potentially better survival is possible [4,29]. To alleviate these concerns, analyses were stratified by different MHT types, and by current versus past use. The fact that we found a better survival for E-MHT among past users, but not among current users, nor past or current EP-MHT users, argues against an impact of socioeconomic factors. Furthermore, a closer clinical follow-up might be favored among MHT users who are at an increased risk of CRC. If these women undergo clinical examinations more frequently, it could result in earlier detection of polyps, cancer or fatal disease selectively among MHT users, possibly leading to under or overestimation of the mortality. However, the discrepant findings for different MHT types suggest that such bias should not explain the observed associations. Moreover, no population-level screening programs for CRC were available during the study period in Sweden.
Association of tibolone and dementia risk: a cohort study using Korean claims data
Published in Gynecological Endocrinology, 2021
Minjung Han, Jooyoung Chang, Seulggie Choi, Yoosun Cho, Gyeongsil Lee, Sang Min Park
Further limitations of our study included failure to include possible confounders, such as menopause and osteoporosis, both of which are associated with increased risk of dementia [13,14]. Also, our study may be affected by the healthy user bias [15]. Even if a higher absolute risk of dementia were to exist in TIB users, this would be masked by the low incidence of dementia in younger age groups [15]. Another limitation is the relatively short follow-up time of our study. While dementia takes a long time to develop, we were only able to observe dementia incidence over 9 years from the index date due to the nature of our data. Moreover, we were not able to adjust for prior use of other forms of exogenous estrogens, such as estrogen therapy and estrogen progestin therapy, since their usage cannot be assessed accurately from the claims database. However, it is noteworthy that in 2002, which is included within the range of our study, the Women’s Health Initiative published reports on the adverse effects of HRT, causing its consumption to decrease by 39% from 2002 to 2006 in Korea [16]. This suggests that adjusting for other HRT use may not significantly change our results, given the small proportion of conventional HRT users during our study period.