Postmenopausal women should not receive unopposed estrogen or combination hormone therapy for the prevention of chronic disease, including heart disease, stroke, and osteoporosis, according to a new recommendation by the U.S. Preventive Services Task Force.
The task force also recommended against using unopposed estrogen therapy for disease prevention in postmenopausal women who have undergone hysterectomy.
In 2002, the task force found insufficient evidence to recommend for or against such preventive therapy. The task force noted that HT has beneficial effects on bone and reduces the risk of colorectal cancer. But after reviewing findings from the Women's Health Initiative study, the task force concluded that the risks of both unopposed estrogen and combined HT probably exceed their benefits.
“These recommendations expand the evidence base physicians depend on to deliver good quality medical care that meets the needs of individual patients,” Carolyn M. Clancy, M.D., who is director of the Agency for Healthcare Research and Quality, said in a statement. “The evidence can also help women become better-informed patients and decide with their clinicians what alternatives are available to prevent these chronic diseases.”
In addition to data from the WHI, the task force based its recommendations on the conclusions of the U.K. Million Women Study and many metaanalyses of other studies. Based on these studies, the force concluded that HT:
▸ Doubles the risk of invasive breast cancer.
▸ Doubles the risk of endometrial cancer.
▸ Doubles the risk of venous thromboembolism.
▸ Increases the risk of stroke by up to 41%.
▸ Increases the risk of heart disease by 29%.
▸ Increases the risk of dementia by about 40%.
The task force acknowledged that the additional risks conferred by HT are small (eight more strokes, eight more pulmonary embolisms, eight more invasive breast cancers, and seven more coronary heart disease events/10,000 women per year), but said patients and physicians should take them into account.
“The balance of benefits and harms for a woman will be influenced by her personal preferences, her risk for specific chronic diseases, and the presence of menopausal symptoms,” according to the task force.
“A shared decision-making approach to preventing chronic disease in perimenopausal and postmenopausal women involves consideration of individual risk factors and preferences in selecting effective interventions for reducing the risks for fracture, heart disease, and cancer.”
The new recommendations are available at www.preventiveservices.ahrq.gov