From the Guidelines
Hormone replacement therapy (HRT) may reduce TNF-alpha levels in postmenopausal women, but the effect varies depending on the specific HRT formulation, dosage, and individual patient factors. The mechanism involves estrogen's ability to inhibit the activation of nuclear factor kappa B (NF-κB), a key transcription factor that regulates TNF-alpha production 1. However, the quality of evidence on the benefits and harms of HRT varies for different hormone regimens, and most of the evidence on HRT comes from observational studies that did not differentiate among the effects of specific hormone preparations 1.
Some key points to consider when evaluating the effect of HRT on TNF-alpha levels include:
- The specific HRT formulation used, with estrogen-based HRT potentially having anti-inflammatory effects that include suppression of TNF-alpha production
- The dosage of HRT, with higher doses potentially having more pronounced effects on TNF-alpha levels
- Individual patient factors, such as the timing of HRT initiation relative to menopause onset, which can influence the anti-inflammatory effects of HRT
- The potential risks and benefits of HRT, including the risk for venous thromboembolism, CHD, and stroke, which should be carefully weighed when making decisions about HRT use 1.
In terms of the evidence, while there is some suggestion that HRT may reduce TNF-alpha levels, the effect is not consistent across all studies, and the quality of the evidence is variable. Therefore, HRT should not be initiated solely for the purpose of reducing TNF-alpha levels, but rather as part of a comprehensive assessment of benefits and risks for each individual.
From the Research
Hormone Replacement Therapy and Tumor Necrosis Factor-alpha Levels
- The effect of Hormone Replacement Therapy (HRT) on Tumor Necrosis Factor-alpha (TNF-alpha) levels is not consistently reported across studies 2, 3, 4, 5, 6.
- One study found that oral estrogen replacement therapy increased C-reactive protein levels, but had no significant effect on TNF-alpha levels 4.
- Another study found that HRT had no significant effect on CA 125, CA 19-9, CEA, and alpha-FP levels, but estradiol led to a significant decrease in post-treatment CA 15-3 levels 5.
- There is no direct evidence to suggest that HRT causes decreased TNF-alpha levels, but some studies suggest that HRT may have anti-inflammatory effects 2, 4.
- A study on patients with thyroid dysfunction found that TNF-alpha levels were elevated in patients with hypothyroidism and hyperthyroidism, but treatment of hyperthyroidism was accompanied by a normalization of TNF-alpha levels 6.