Recommendations on combined hormone therapy
The U.S. Preventive Services Task Force (USPSTF) has issued new recommendations against the use of combined estrogen and progestin therapy for preventing cardiovascular disease and other chronic conditions in postmenopausal women. The recommendations are available online at www.ahrq.gov.
In 1996, the USPSTF found insufficient evidence to recommend for or against taking hormone therapy to prevent chronic conditions. Now, after reviewing additional studies, including recent clinical trial data that showed the risks of hormone therapy, the USPSTF recommends against taking estrogen and progestin to prevent long-term health problems (a “D” recommendation), and found insufficient evidence to recommend for or against the use of estrogen alone in women who have had a hysterectomy (an “I” recommendation).
The USPSTF found evidence for both benefits and harms of combined estrogen and progestin therapy, one of the most commonly prescribed hormone regimens. However, the USPSTF concluded that harmful effects of the combined therapy are likely to exceed the chronic disease prevention benefits for most women.
Evidence is insufficient to recommend for or against the use of estrogen alone for prevention of chronic conditions in postmenopausal women who have had a hysterectomy. A study of estrogen therapy in women who have had hysterectomies is continuing as part of the National Institutes of Health (NIH) Women’s Health Initiative because it has not yet found clear benefit or harm.
The USPSTF examined hundreds of studies, including the recently terminated trial within the NIH’s Women’s Health Initiative, which reported the effects of taking combined estrogen and progestin therapy on a variety of chronic diseases. The USPSTF concluded that combined hormone therapy could increase bone mineral density, reduce the risk of fractures, and may reduce the risk of colorectal cancer. The USPSTF found equally strong evidence, however, that combined hormone therapy increases the risk for breast cancer, blood clots, stroke, and gallbladder disease. In addition, evidence suggests that hormone therapy does not reduce the risk of heart disease, and that estrogen and progestin combined actually increase the risk of heart attacks. The effects of hormone therapy on dementia, cognitive function, and ovarian cancer are uncertain.
An estimated 14 million American women take hormone therapy to help relieve hot flushes and other menopausal symptoms, as well as to prevent chronic conditions such as heart disease. The use of hormone therapy to treat hot flushes or other symptoms of menopause was not evaluated by the USPSTF.
The USPSTF recommends that women who are considering starting or continuing hormone therapy to relieve menopausal symptoms discuss their individual risks for specific chronic conditions and personal preferences with their physician.
COPYRIGHT 2002 American Academy of Family Physicians
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