title: Effect of menopause hormone therapy on disease progression in systemic lupus erythematosus: A systematic review.
abstract: OBJECTIVE
  To review the literature pertaining to the effect of postmenopausal hormone therapy on disease progression in women with systemic lupus erythematosus.
  
  
  METHODS
  We performed a systematic review using PubMed, Embase, and the Cochrane Central Register of Controlled Trials from January 1990 to December 2013 for observational studies and randomized clinical trials that study the effect of hormone therapy on the occurrence of flares in menopausal patients with systemic lupus erythematosus. The screenings of titles and abstracts, full text review, and risk of bias assessments were done by two independent reviewers.
  
  
  RESULTS
  A total of 12,548 articles were identified. After title and abstract screening and removal of duplicates, 692 articles were retrieved for full text review. Five studies were deemed eligible for inclusion in the analysis, and the methodological quality was assessed. Two of the studies were randomized controlled trials and three were observational studies. One randomized controlled trial found that menopausal women who received hormone therapy were at a higher risk for developing minor to moderate flares of systemic lupus erythematosus. In the other four studies, there was no significant difference in systemic lupus erythematosus disease activity between hormone therapy and non-hormone therapy users.
  
  
  CONCLUSIONS
  Hormone therapy in menopausal patients with systemic lupus erythematosus appears to be well tolerated. While there is some evidence supporting an increase in risk of mild to moderate flares among hormone therapy users, no association was identified between hormone therapy use and severe disease flares. In addition, hormone therapy was associated with significant improvement in menopausal symptoms and quality of life. Larger trials are required to assess the long-term effects of hormone therapy on the course of systemic lupus erythematosus in menopausal patients and to identify patient characteristics associated with an increased risk of flares in the setting of hormone therapy exposure.
authors.affiliation: Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Ayatallah M
authors.initials: AM
authors.lastname: Khafagy
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Katherine I
authors.initials: KI
authors.lastname: Stewart
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mindy S
authors.initials: MS
authors.lastname: Christianson
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ye
authors.initials: Y
authors.lastname: Tao
authors.affiliation: Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jaime F
authors.initials: JF
authors.lastname: Blanck
authors.affiliation: Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: wshen1@jhmi.edu.
authors.forename: Wen
authors.initials: W
authors.lastname: Shen
mesh_terms: D018450:Disease Progression; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology*; D008593:Menopause; D011788:Quality of Life
keywords: Autoimmune disease; Hormone therapy; Menopause; Systematic review; Systemic lupus erythematosus