Hormone Therapy After Menopause Upped Pancreatitis Risk

Postmenopausal hormone replacement therapy increased risk of pancreatitis

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Many women use hormone replacement therapy to help with menopause symptoms. But the treatment does carry some increased risks for developing other medical conditions.

A recent study found that hormone replacement therapy (HRT) after menopause was associated with an increased risk for acute pancreatitis.

The results of this study showed that the highest risks were for women who used systemic HRT and those who used it more than ten years.

"Discuss the risks of hormone replacement therapy with your doctor."

The lead author of this study was Viktor Oskarsson, MD, from the Unit of Nutritional Epidemiology in the Institute of Environmental Medicine at the Karolinksa Institutet in Stockholm, Sweden.

The study included 31,494 postmenopausal women from a previous study called the Swedish Mammography Cohort.

All the participants of the current study were between the ages of 48 and 83 years old at the beginning of the study in 1997.

None of the participants had a history of pancreatitis or cancer, with the exception of nonmelanoma skin cancer.

The participants filled out a questionnaire at the start of the study on their use of HRT, including age of first menstrual period, age of menopause, type of HRT, duration of HRT use and reason for using HRT.

In addition, dietary habits, alcohol intake, smoking status, current medications, medical history (including history of diabetes), history of oral contraceptives, education level, number of births, waist circumference and body mass index (weight to height ratio) were recorded at the start of the study.

At the beginning of the study, 13,113 participants (42 percent) were current users of HRT and 3,660 participants (12 percent) were past users.

The researchers followed up with participants at the end of 2010, looking for any cases of pancreatitis that occurred between September 15, 2007 and December 31, 2010.

The findings showed that there were 237 cases of pancreatitis at follow-up.

Of the current users of HRT, 6,795 (52 percent) used systemic estrogen, which is taken as a pill, skin patch, gel, cream or spray; 4,148 participants (32 percent) used local estrogen, which is taken vaginally; and 2,170 (17 percent) used both.

The researchers determined that the incidence rate of pancreatitis among participants who had ever used any form of HRT was 71 cases per 100,000 person-years.

Among the participants who did not use HRT, the incidence rate of pancreatitis was 52 cases per 100,000 person-years.

Compared to the participants who did not use HRT, the participants who had ever used any form of HRT were 57 percent more likely to have pancreatitis.

The findings revealed that the risk of pancreatitis did not differ significantly between past and current users.

Systemic HRT users were 92 percent more likely to have pancreatitis than those who used local HRT.

The participants who used any type of HRT for more than 10 years were 87 percent more likely to have pancreatitis compared to the participants who never used HRT or used HRT for 10 or less years.

Among the participants who used HRT for more than 10 years, the participants who used systemic HRT were 2.44 times more likely to have pancreatitis than those who used local HRT.

The researchers discovered that the overall risk of pancreatitis was not significantly affected by adjustments for waist circumference, average alcohol use per occasion, age of first menstrual period, number of births, oral contraceptive use or history of diabetes.

Lastly, every two years of HRT use increased the risk of pancreatitis by 9 percent.

The authors of this study concluded that the risk of pancreatitis should be considered when deciding whether or not to use HRT.

These authors noted a few limitations of their study. First, the data on HRT use was self-reported. Second, there was no data on the specific preparation, dose and route of administration of HRT. Third, the cases of pancreatitis were identified according to the Swedish National Patient Register, and the diagnosis could be been a misclassification. Fourth, the researchers may not have accounted for every potential variable.

This study was published on January 27 in the Canadian Medical Association Journal.

The Swedish Research Council's Committee for Infrastructure and the Karolinska Institutet provided funding.

Review Date: 
January 27, 2014
Last Updated:
January 28, 2014