Postmenopausal Hormone Replacement Therapy To Prevent Chronic Conditions: Recommendations from the U.S. Preventive Services Task Force

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The summary below is from the full reports titled "Postmenopausal Hormone Replacement Therapy for Primary Prevention of Chronic Conditions: Recommendations and Rationale" and "Postmenopausal Hormone Replacement Therapy and the Primary Prevention of Cardiovascular Disease." The first report is in the 19 November 2002 issue of Annals of Internal Medicine (volume 137, pages 834-839), and the second report is in the 20 August 2002 issue (volume 137, pages 273-284). The first report was written by the U.S. Preventive Services Task Force; the second report was written by LL Humphrey, BKS Chan, and HC Sox. The complete USPSTF recommendation and rationale statement and the complete information on which this statement is based are available at http://www.preventiveservices.ahrq.gov.

What is the U.S. Preventive Services Task Force?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Around menopause, decreases in the levels of the hormones estrogen and progesterone result in hot flashes, night sweats, mood swings, and vaginal dryness. Lower hormone levels also increase bone loss and the risk for heart disease. Postmenopausal hormone replacement therapy (HRT) consists of taking estrogen with or without progesterone. Some women take HRT to relieve the uncomfortable symptoms of menopause. Others take it to reduce the risk for osteoporosis (thinning of the bones that can lead to fractures), which is a proven effect of HRT, and some take HRT with the hope of decreasing their chances of heart disease, colon cancer, or dementia. However, the effect of HRT on these conditions has been uncertain. HRT has side effects and does appear to increase the risk for certain diseases such as stroke, blood clots, and breast cancer. It has been unclear whether the potential benefits of postmenopausal HRT to prevent some chronic conditions are worth the associated risks.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research to evaluate the benefits and harms of postmenopausal HRT.

What did the authors find?

The most certain long-term benefit of HRT is the decreased risk for osteoporosis-related fractures. Possible but unproven benefits include reduced risk for dementia. HRT using only estrogen also increases the risk for uterine cancer, but a woman can eliminate this risk by taking progesterone with estrogen. Other negative effects of HRT include blood clots and gallstones. A recent study, the Women's Health Initiative, provided strong evidence that HRT causes small but definite increases in a women's risk for heart disease, stroke, and breast cancer. This study showed that HRT decreases the risk for colon cancer and for osteroporosis-related fractures. Since HRT increases the risk for heart disease and breast cancer, the harms outweigh the benefits for most women.

What does the USPSTF suggest that patients do?

The USPSTF recommends against women taking HRT for the sole purpose of preventing chronic conditions. The decision about whether to take HRT to reduce the symptoms of menopause will depend on each woman's preferences and personal risk for osteoporosis, heart disease, dementia, blood clots, stroke, and cancer. Women considering taking HRT for any reason should discuss the potential benefits and risks with their doctors.

What are the cautions related to these recommendations?

As better studies become available, the USPSTF may modify these recommendations. These recommendations do not address decisions about whether to use short-term HRT (<5 years) to treat menopausal symptoms or the use of estrogen alone after hysterectomy.