Menopausal hormone therapy use carries increased T2DM risk

The use of menopausal hormone therapy (MHT), including the most prescribed agent tibolone, appears to contribute to an increase in the risk of type 2 diabetes mellitus (T2DM), as shown in a retrospective study.

In the study, researchers used national health insurance data and cancer screening data, identifying postmenopausal women aged >40 years who used at least one MHT for at least 6 months between 2003 and 2011. MHT was grouped into five, as follows: tibolone, combined estrogen plus progestin by the manufacturer (CEPM), oral estrogen, combined estrogen plus progestin by the physician (CEPP), and transdermal estrogen.

In addition, a control group that included postmenopausal women who had never been prescribed MHT from 2002 to 2019 was included. The incidence of T2DM was then compared between the MHT group and the control group.

The MHT group consisted of 330,771 women, while the control group comprised 798,550 women. T2DM was diagnosed in 15.2 percent of the control group, 16.6 percent of the tibolone subgroup, 12.1 percent of the CEPM subgroup, 16.6 percent of the oral estrogen subgroup, 15.4 percent of the CEPP subgroup, and 17 percent of the transdermal estrogen subgroup.

Multivariable Cox proportional hazard analysis showed that exposures to tibolone, oral estrogen, CEPP, and transdermal estrogen were all associated with an increased incidence of T2DM as compared with nonexposure. Of note, the risk increase associated with MHT use among participants >70 years of age was only observed among tibolone users.

Meanwhile, CEPM had a null association with the risk of T2DM.