A systematic review of nine randomized, placebo-controlled trials published to assess the effectiveness of menopausal hormone therapy in the prevention of chronic conditions revealed: estrogen plus progestin and estrogen alone decreased risk for fractures but increased risk for stroke, thromboembolic events, gallbladder disease, and urinary incontinence; estrogen plus progestin increased risk for breast cancer and probable dementia; and estrogen alone decreased risk for breast cancer.
At one time, menopausal hormone therapy was routinely used by postmenopausal women to prevent cardiovascular disease, dementia, osteoporosis and other chronic conditions. However, once initial results of the Women’s Health Initiative (WHI) trials emerged in 2002 indicating important adverse health effects of this treatment, the U.S. Preventive Services Task Force (USPSTF) issued recommendations against using hormone therapy to prevent chronic conditions for estrogen plus progestin in 2002, and for estrogen only in 2005.
Other groups provided similar recommendations, and currently, the FDA indications for hormone therapy use include short-term treatment of menopausal symptoms, such as vasomotor hot flashes or urogenital atrophy, and prevention of osteoporosis.
Heidi D. Nelson, MD, MPH, and colleagues undertook the current systematic review for the USPSTF to update the group’s recommendations. The investigator’s findings, which were published online ahead of print in Annals of Internal Medicine, will inform an upcoming USPSTF recommendation for menopausal hormone therapy.