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Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: US Preventive Services Task
, David C Grossman1, Susan J Curry2
1Kaiser Permanente Washington Health Research Institute, Seattle.
Insights
Menopausal hormone therapy offers limited benefits but carries risks for preventing chronic conditions. The US Preventive Services Task Force recommends against its use for most postmenopausal women.
Area of Science:
- Preventive medicine
- Women's health
- Endocrinology
Background:
- Menopause, occurring around age 51, is associated with increased chronic disease risk.
- Postmenopausal hormone therapy use has declined due to safety concerns.
Purpose of the Study:
- To update recommendations on menopausal hormone therapy for chronic condition prevention.
- Evaluate benefits and harms of systemic hormone therapy in postmenopausal women.
Main Methods:
- Systematic review of evidence on hormone therapy for primary prevention of chronic conditions.
- Analysis of benefits, harms, and subgroup variations.
Main Results:
- Hormone therapy shows small to moderate benefits and harms.
- Combined estrogen-progestin offers no net benefit for women with a uterus.
- Estrogen alone offers no net benefit for women without a uterus.
Conclusions:
- The US Preventive Services Task Force recommends against combined estrogen-progestin therapy.
- The US Preventive Services Task Force recommends against estrogen-alone therapy for women post-hysterectomy.
Importance:
Menopause occurs at a median age of 51.3 years, and the average US woman who reaches menopause is expected to live another 30 years. The prevalence and incidence of most chronic conditions, such as coronary heart disease, dementia, stroke, fractures, and breast cancer, increase with age; however, the excess risk for these conditions that can be attributed to menopause alone is uncertain. Since the publication of findings from the Women's Health Initiative that hormone therapy use is associated with serious adverse health effects in postmenopausal women, use of menopausal hormone therapy has declined.
Objective:
To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on the use of menopausal hormone therapy for the primary prevention of chronic conditions.
Evidence Review:
The USPSTF reviewed the evidence on the benefits and harms of systemic (ie, oral or transdermal) hormone therapy for the prevention of chronic conditions in postmenopausal women and whether outcomes vary among women in different subgroups or by timing of intervention after menopause. The review did not address hormone therapy for preventing or treating menopausal symptoms.
Findings:
Although the use of hormone therapy to prevent chronic conditions in postmenopausal women is associated with some benefits, there are also well-documented harms. The USPSTF determined that the magnitude of both the benefits and the harms of hormone therapy in postmenopausal women is small to moderate. Therefore, the USPSTF concluded with moderate certainty that combined estrogen and progestin has no net benefit for the primary prevention of chronic conditions for most postmenopausal women with an intact uterus and that estrogen alone has no net benefit for the primary prevention of chronic conditions for most postmenopausal women who have had a hysterectomy.
Conclusions And Recommendation:
The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal women. (D recommendation) The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal women who have had a hysterectomy. (D recommendation).
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