Hormone replacement therapy (HRT) is not recommended for preventing chronic disease among post-menopausal women, as the health risks it poses outweigh its likely benefits.
That’s the latest word from the United States Preventive Services Task Force (USPSTF), which issued its updated statement regarding HRT Monday evening. The statement, published online in the Annals of Internal Medicine, 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.
The USPSTF’s review of research published since 2005, when that organization last published recommendations about post-menopause use of HRT, revealed that combined estrogen and progestin therapy after menopause reduces the risk of bone fractures. But women taking that combined hormone therapy 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.
Among post-menopausal women who have had a hysterectomy, taking estrogen alone reduces fracture risk and appears to lower breast-cancer risk. But it doesn’t reduce heart-disease risk and may increase the risk of stroke, blood clots, gallbladder disease and incontinence, the USPSTF found.
A USPSTF fact sheet presenting the findings in simplified form spells out the numbers: 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.
For every 10,000 women using estrogen alone, the fact sheet notes, 56 may avoid a fracture, eight avoid developing and two avoid dying from breast cancer. But 11 may have a stroke, seven develop a serious blood clot in their legs, 33 develop gallbladder disease and 1,271 develop urinary incontinence.
Using HRT did not affect risk of heart disease in either group.
Michael LeFevre, one of two vice-chairs of the USPSTF, says, “The most important message of women is that these recommendations are about hormone replacement therapy and chronic disease, not about symptoms related to hormone changes or estrogen depletion” related to menopause.
“If a woman is miserable with symptoms of menopause, we encourage them to talk with their health-care provider” to determine whether, in her individual case, the benefits of using HRT to relieve menopause symptoms outweigh the risks.
The USPSTF, an independent panel of primary-care providers who are experts in prevention and evidence-based medicine, conducts scientific evidence reviews of preventive health care services and issues recommendations to guide primary care clinicians and health systems.
“Our goal, which we do not always achieve, is to update all of our recommendations about every five years,” LeFevre says. “In this particular circumstance, there was indeed science that we had to examine” that had been published since the last recommendations were formulated. That new science did not change the recommendations, LeFevre says, but rather reinforced the message issued in 2005.
Here’s a patient-friendly version of the new recommendations.