The United States Preventive Services Task Force held to its stance against the use of estrogen and progestin for the prevention of chronic medical conditions in postmenopausal women and the use of estrogen alone for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.
These are both Grade D recommendations (moderate or high certainty that the service has no net benefit or that harms outweigh the benefits), and have not changed since the Task Force's previous recommendations in 2005.
The recommendation appeared online Oct. 22 in Annals of Internal medicine.
Following a review of 51 articles published since 2002, the Task Force concluded that risks associated with these hormone replacement therapies (HRT) outweigh the chronic disease prevention benefits. Specifically:
--Estrogen alone and estrogen plus progestin reduce the risk for fractures, but increase risk for stroke, thromboembolic events, gallbladder disease and urinary incontinence.
--Estrogen alone decreased risk for breast cancer.
--Estrogen plus progestin increased risk for probable dementia and breast cancer.
--The risk for breast cancer increased for women with prior oral contraceptive use, prior menopausal estrogen plus progestin therapy, or current smoking.
The recommendations apply to average-risk women who have undergone menopause, and are not about the use of hormone therapy to treat symptoms of menopause, such as hot flashes or vaginal atrophy.
The USPSTF said in the report that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation.
Juliet K. Mavromatis, MD, FACP, is a primary care physician in Atlanta, Ga., addressed just how to do that in her blog.
The Task Force provided a patient guide to help doctors explain the issues to their patients.
And, ACP Internist detailed how physicians, researchers and women have been experimenting with alternative solutions to the problems of menopause, including non-oral hormone formulations, smaller doses and non-hormonal therapies. Even today, nearly one in 10 doctors prescribes hormone replacement therapy for patients, a survey found.