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U.S. Preventive Services Task Force Advises Against Hormone Therapy for Chronic Conditions

The USPSTF has confirmed its 2005 recommendation against the use of estrogen and progestin for postmenopausal women with chronic medical conditions.

--by Nina Lincoff

The Gist

In the United States, the average woman who reaches menopause (at approximately 50 years old) is expected to live an additional 30 years. During that time, the estimated risk for developing coronary heart disease (CHD) is 30 percent, 22 percent for dementia, 21 percent for stroke, 15 percent for hip fracture, and 11 percent for breast cancer. These five ailments are considered chronic medical conditions, and in some cases, hormone treatment—specifically the injection of estrogen, progestin, or a combination of both—is prescribed.

Hormone therapy, which is the use of medications containing female hormones to replace ones the body no longer produces after menopause, has long been used to treat postmenopausal symptoms. Since a large study found that these therapies, often involving the hormones estrogen and progestin, are associated with harmful risks in postmenopausal women with chronic medical conditions, there has been an industry shift away from such treatments.

The U.S. Preventive Services Task Force (USPSTF) stands by its 2005 recommendation against such treatment in postmenopausal women in a survey released earlier today. After reviewing 51 articles and studies from the past seven years, researchers from the USPSTF concluded that the use of estrogen and progestin in treating chronic medical conditions in postmenopausal women is unsafe and can lead to potentially harmful health outcomes. The survey reports that there is adequate evidence that use of these hormones in postmenopausal women is associated with “an increase in the risk for stroke, dementia, gallbladder disease, and urinary incontinence,” in addition to a small increase in invasive breast cancer incidence.

The 2005 USPSTF recommendations, several large trials of the Women’s Health Initiative, and reports from other task forces has lead to a decrease in the use of hormone therapy for chronic conditions in postmenopausal women. Common practice has been to use hormone therapy only to treat menopausal symptoms, such as hot flashes.

The Expert Take

“We stand by the same recommendation that we made in 2005,” said Kristen Bibbins-Domingo, MD, a researcher with the USPSTF. “The reason we updated the report is new evidence and long-term follow-up that allowed us again to reaffirm with confidence that, on balance, these therapies don’t seem to work in chronic conditions. Heart disease is just one harmful effect associated with hormone treatment, although how to prevent chronic conditions is still of interest."

Hormone therapy is something women and their doctors take into consideration when treating postmenopausal symptoms, which are different from the chronic medical conditions considered in the USPSTF survey.  “Treatment of postmenopausal symptoms was not considered in our review,” said Bibbins-Domino, “but that is a discussion that many women and their health care providers are having.”

The Bottom Line

Because of the associated risks, the use of hormone treatment utilizing estrogen and progestin is not recommended for postmenopausal women as a prescription for chronic medical conditions.

“With any woman seeking therapy to prevent chronic conditions, we always hope that it starts with a conversation with a health care provider," said Bibbins-Domingo. "There’s nothing in our guidelines that replace what a women and her health care providers decide about their health." The USPSTF recommendation is a simply a synthesis of the large body of evidence about the dangers of hormone therapy. What the USPSTF hopes, said Bibbins-Domingo, is that health care providers and women take the time to read the full report.

The real utility of large-scale surveys like the ones conducted by the USPSTF is that a vast amount of evidence is considered and aggregated by medical professionals and researchers. “We really outline all the aspects of the evidence and areas of gaps in the research,” said Bibbins-Domingo. Hopefully further research will shed additional light on unknowns in the field of hormone treatment and chronic medical conditions.

The use of hormone treatments closer to the onset of menopause is something Bibbins-Domingo hopes will be examined more closely in the future. “There needs to be more information out there, and there are women who are younger than our target group who may have differing risks,” she said.

Source and Method

The USPSTF reviewed literature on the efficacy of hormone therapy using estrogen and progestin to form an educated update on the recommendation for or against such treatment. Recommendations are updated when significant new research is published pertaining to such treatments.

Other Resources

Evidence for this studied was previously published in July. The Mayo Clinic has a useful online resource for women wishing to learn more about hormone therapy that aligns with the findings of the USPSTF.

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Tags: Drugs , Latest Studies & Research , Public Health & Policy

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