The US Preventive Services Task Force (USPSTF) recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal persons, as well as the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy. Both recommendations were given a “D” grade indicating that there is moderate or high certainty that the harms associated with hormone therapy use in these settings outweigh any potential benefits.

The recommendations follow a systematic review of 20 trials (N=39,145) and 3 cohort studies (N=1,155,410). The use of estrogen alone was associated with some benefits, including a statistically significant reduction in the risk for fractures and diabetes. However, estrogen alone was also linked to several harms, including higher risks of stroke, thromboembolic events, gallbladder disease and urinary incontinence.

With regard to the combination of estrogen and progestin, statistically significant reductions in the risks for colorectal cancer, fractures, and diabetes were noted when compared with placebo. Findings also identified several harms with the combination therapy including increased risk for invasive breast cancer, coronary heart disease, probable dementia, gallbladder disease, stroke, urinary incontinence and venous thromboembolism.


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The Task Force does note several limitations of the review including how age and timing of hormone therapy may affect outcomes, whether the effect of hormone therapy is different across population groups, and how different formulations and treatment durations impact the benefits and harms.

“Importantly, this recommendation is only for people who are considering hormone therapy to prevent chronic conditions after going through menopause,” said Task Force member James Stevermer, MD, MSPH. “Those who wish to manage symptoms of menopause with hormone therapy are encouraged to talk with their health care professional.”

References

  1. US Preventive Services Task Force. Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons. US Preventive Services Task Force recommendation statement. Published online November 1, 2022. JAMA. doi:10.1001/jama.2022.18625
  2. Gartlehner G, Patel SV, Reddy S, et al. Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons. Updated evidence report and systematic review for the US Preventive Services Task Force. Published online November 1, 2022. JAMA. doi:10.1001/jama.2022.18324
  3. US Preventive Services Task Force. Task Force issues final recommendation statement on hormone therapy for preventing chronic conditions in postmenopausal people. News release. November 1, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/hormone-therapy-postmenopause-final-rec-bulletin.pdf

This article originally appeared on MPR