The Task Force’s review of research published since 2005 showed that combined estrogen and progestin therapy after menopause reduces the risk of bone fractures. But women taking that combined HRT do not decrease their risk of heart disease, and they are actually at increased risk of breast cancer, stroke, blood clots, gallbladder disease, dementia and urinary incontinence.
A Task Force fact sheet posted on the group’s Web site said that for every 10,000 women who use combined therapy each year, 46 may avoid a fracture. But eight may develop breast cancer, nine may have a stroke, nine may develop a serious blood clot in their lungs, 12 may develop a serious blood clot in their legs, 20 may develop gallbladder disease, 22 may develop dementia and 872 may develop urinary incontinence.
The group said it was addressing only the use of HRT for chronic disease. The recommendation, it said, does not apply to the use of HRT for managing symptoms of menopause such as hot flashes and vaginal dryness. Nor does it apply to women younger than 50 who have had a hysterectomy.
“If a woman is miserable with symptoms of menopause,” said Michael LeFevre, one of two vice-chairmen of the Task Force, “we encourage them to talk with their health-care provider” to determine whether the benefits of HRT outweigh the risks.
The Task Force is an independent panel of primary-care providers who are experts in prevention and evidence-based medicine; they issue recommendations to guide primary-care clinicians and health systems.
The Task Force findings echo an earlier report. In 2002, the federally funded Women’s Health Initiative found that hormones’ benefits were outweighed by risks, including heart disease and breast cancer. After the report, hormone use plummeted by more than half.
In 2010 the Initiative found that women who used HRT were more likely to have tumors that appeared to be larger and were more likely to have spread to their lymph nodes. But most important, their risk of death appeared elevated.