Although some recent studies have hinted that hormone replacement therapy may be beneficial for some postmenopausal women, the US Preventive Services Task Force continues to recommend against its use for the prevention of chronic medical conditions. The task force’s recommendation, a reaffirmation of its earlier position, appears today in the Annals of Internal Medicine.
For many years, clinicians routinely prescribed hormone replacement therapy for many postmenopausal women for the purpose of preventing such chronic conditions as heart disease, dementia, and osteoporosis. But the therapy fell out of favor, prompted by the release of trial results from the Women’s Health Initiative, published in JAMA in 2002 and 2004, which suggested the risks of taking estrogen alone or combined with progestin outweighed the benefits.
In making its recommendation, the task force considered 51 full-text articles from 9 trials published between January 2002 and November 2011. The task force concluded that estrogen plus progestin and estrogen alone decreased the risk for bone fractures but increased the risk for stroke, thromboembolic events (deep vein thrombosis and pulmonary embolism), gallbladder disease, and urinary incontinence. Estrogen plus progestin increased the risk for breast cancer and probable dementia, while estrogen alone decreased the risk for breast cancer. The task force recommendations apply to average-risk women who have undergone menopause and do not apply to the use of hormone therapy to treat symptoms of menopause, such as hot flashes or vaginal atrophy.
The authors of the recommendation said that because their findings are based on trials enrolling older women who were years past menopause, more research is needed involving women who are transitioning through menopause or who are immediately postmenopausal.
In one small study of such women, recently published in BMJ, the authors noted that conflicting findings from observational and randomized studies might reflect the fact that the randomized trials often involved women who start hormone therapy many years (5 to 20 years) after menopause and said the positive cardiovascular effects seen in observational studies probably were the result of hormone replacement therapy starting shortly after menopause. In their study, which included 1006 healthy Danish women who were recently postmenopausal or who were undergoing menopause, the authors concluded that after 10 years, women being treated with hormone replacement therapy greatly reduced their risk of mortality, heart failure, or heart attack, without any apparent increase in cancer, venous thromboembolism, or stroke risk when compared with women taking a placebo.