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

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The summary below is from the full report titled "Hormone Therapy for the Prevention of Chronic Conditions in Postmenopausal Women: Recommendations from the U.S. Preventive Services Task Force." It is in the 17 May 2005 issue of Annals of Internal Medicine (volume 142, pages 855-860). It was written by the U.S. Preventive Services Task Force.

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, the levels of the hormones estrogen and progestin decrease, resulting in hot flashes, sweats, mood swings, and vaginal dryness. Lower hormone levels increase bone loss and the risk for heart disease. Postmenopausal hormone therapy (HT) involves taking estrogen with or without progestin. Combination HT refers to taking both hormones and is necessary in women with a uterus because estrogen alone greatly increases the risk for uterine cancer (also called endometrial cancer). Women who have no uterus because they have had a hysterectomy can take estrogen alone because they cannot get uterine cancer. Some women take HT to relieve menopausal symptoms, others take it to reduce the risk for osteoporosis (thinning of the bones that can lead to fractures), and some take it because they hope it will decrease their chances of getting colon cancer or developing problems with memory or thinking. In 2002, the USPSTF recommended against postmenopausal women taking combination HT for the sole purpose of preventing chronic conditions. However, at that time there was insufficient information for the USPSTF to make a definite recommendation about the use of estrogen alone.

How did the USPSTF develop these recommendations?

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

What did the USPSTF find?

The USPSTF found good evidence that HT (combined and estrogen alone) results in both benefits and harms. The most certain long-term benefit of HT is the decreased risk for osteoporosis-related fractures. Combination HT decreases colorectal cancer risk, but the effect of estrogen alone is uncertain. Hormone therapy does not decrease the risk for heart disease, and evidence suggests that combination HT actually increases heart disease risk. Hormone therapy increases the risk for blood clots, stroke, and problems with memory and thinking. Combination HT increases the risk for gall bladder problems. The effect of HT on breast cancer survival, ovarian cancer, and overall survival is uncertain. The USPSTF concluded that the harmful effects of either combined HT or estrogen alone probably outweigh the benefits of chronic disease prevention.

What does the USPSTF suggest that patients do?

The USPSTF recommends against postmenopausal women taking combined HT for the sole purpose of preventing chronic conditions.

The USPSTF recommends against postmenopausal women who have had a hysterectomy taking estrogen alone for the sole purpose of preventing chronic conditions.

The decision about whether to take HT for menopause symptoms will depend on each woman's preferences and personal risk for osteoporosis, heart disease, and cancer. Women considering taking HT 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.