Menopausal hormone therapy for chronic conditions: USPSTF's final recommendation

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The USPSTF has updated its recommendations on the use of menopausal hormone therapy for the primary prevention of chronic conditions.
The USPSTF has updated its recommendations on the use of menopausal hormone therapy for the primary prevention of chronic conditions.

The US Preventive Services Task Force (USPSTF) has released its final recommendation statement on the use of menopausal hormone therapy for the primary prevention of chronic conditions, as published in JAMA.

To update its 2012 recommendation, the task force reviewed evidence on the benefits and harms of systemic 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.

For the use of combined estrogen and progestin hormone therapy, the USPSTF found convincing evidence that combination therapy is associated with moderate harms, including increased risk of invasive breast cancer and venous thromboembolism, and a small to moderate harm of increased risk of coronary heart disease. The USPSTF also found adequate evidence of other moderate harms, such as increased risk of stroke, dementia, gallbladder disease, and urinary incontinence. Therefore, 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 found adequate evidence that use of estrogen alone is associated with moderate harms, including an increased risk of stroke, dementia, gallbladder disease, urinary incontinence, and venous thromboembolism. The task force recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal women who have had a hysterectomy (D recommendation).

This recommendation statement applies to asymptomatic, postmenopausal women who are considering hormone therapy for the primary prevention of chronic medical conditions. It does not apply to women who are considering hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness. It also does not apply to women who have had premature menopause (primary ovarian insufficiency) or surgical menopause.

In a related editorial published in JAMA Internal Medicine, Deborah Grady, MD, MPH, commented, “Of note, there is no evidence that use of [hormone therapy] for 5 to 7 years increases overall mortality. When adequately informed, women with moderate to severe symptoms and without contraindications should be able to take such small risks if HT improves symptoms and quality of life. Multiple professional societies, including the North American Menopause Society, the American College of Obstetricians and Gynecologists, and the Endocrine Society support the use of HT in symptomatic, recently menopausal women.”

References

  1. Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: US Preventive Services Task Force Recommendation Statement. JAMA. 12 Dec 2017. doi:10.1001/jama.2017.18261
  2. Grady D. Evidence for postmenopausal hormone therapy to prevent chronic conditions: Success, failure, and lessons learned. JAMA Intern Med. 12 Dec 2017. doi:10.1001/jamainternmed.2017.7861
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