Hormone Therapy To Prevent Chronic Conditions in
Postmenopausal Women: Recommendations from 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.
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