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Panel: Hormone Therapy Not for Disease Prevention

Panel: Hormone Therapy Not for Prevention of Chronic Conditions More Risk Than Benefit When Hormone Therapy Used to Prevent Chronic Conditions WebMD Medical News By Daniel J. DeNoon Reviewed by...

May 29, 2012 -- Women should not use hormone therapy (HT) to prevent chronic conditions, such as bone loss, after menopause.

The advice is the draft recommendation of the U.S. Preventive Services Task Force (USPSTF). It does not apply to women using hormone therapy to treat menopausal symptoms such as hot flashes.

"We are just looking at women without symptoms who are trying to prevent something bad from happening in the future," the leader of the task force's HT analysis, Kirsten Bibbins-Domingo, MD, PhD, tells WebMD. Bibbins-Domingo is associate professor of medicine at the University of California, San Francisco.

The task force made its recommendation after reviewing an analysis of the latest HT research by Heidi D. Nelson, MD, MPH, and colleagues at Oregon Health & Science University.

"The last time the task force looked at this, they discouraged use of HT for any chronic condition," Nelson tells WebMD. "And in the real world, there may be some women who took HT for menopausal symptoms and are wondering whether to stay on it. These findings really apply to using HT after the symptoms of menopause are over."

The updated analysis relies heavily on the now-famous Women's Health Initiative (WHI) study in which older, mostly postmenopausal women received either a placebo or HT. In that trial, treated women got a form of estrogen called conjugated equine estrogen (CEE, derived from horse urine) plus progestin. Women who had undergone hysterectomy received estrogen (CEE) alone.

Benefits of Hormone Therapy to Prevent Disease

Hormone therapy clearly had some benefits in preventing chronic conditions. Women getting estrogen plus progestin had:

  • Fewer fractures
  • A lower risk of diabetes

Women getting estrogen alone had:

  • Fewer fractures
  • A lower risk of invasive breast cancer
  • A lower risk of breast cancer death

Harms of Hormone Therapy to Prevent Disease

But hormone therapy had clear harms as well. Women getting estrogen plus progestin had:

  • Higher risk of invasive breast cancer
  • Higher risk of breast cancer death
  • Higher risk of stroke
  • Higher risk of blood clots in the leg (DVT)
  • Higher risk of blood clots in the lung
  • Higher risk of gallbladder disease
  • Higher risk of dementia
  • Higher risk of urinary incontinence
  • Higher risk of lung cancer death

Women getting estrogen alone had:

  • Higher risk of stroke
  • Higher risk of blood clots in the leg (DVT)
  • Higher risk of gallbladder disease
  • Higher risk of urinary incontinence

"On balance, weighing the benefits against the harms led us to say we would not use these therapies for the prevention of chronic conditions," Bibbins-Domingo says. "It really doesn't work for most of the conditions we considered. And for the biggest benefit, osteoporosis, the harms far outweigh that benefit."

The panel took into account the fact that other effective ways to prevent osteoporosis are available.

What Do the USPSTF Recommendations on HT for Prevention of Chronic Disease Mean?

Here's the exact language of the draft recommendations:

  • The U.S. Preventive Services Task Force (USPSTF) recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women. This is a grade D recommendation. (Discourage the use of this service.)
  • The USPSTF recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. This is a grade D recommendation.
  • This recommendation applies to postmenopausal women who are considering hormone therapy for the primary prevention of chronic medical conditions. This recommendation does not apply to women younger than 50 who have undergone surgical menopause. This recommendation does not consider the use of hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness.

The draft recommendations are posted on the USPSTF web site. Anybody who would like to post comments and/or recommend changes is welcome to do so. After considering these comments, the USPSTF will issue its final recommendations.

What will that mean?

The USPSTF is an independent panel of experts in preventive and family medicine. Members are appointed for a four-year term. Their job is to evaluate medical evidence for preventive medicine. Topics are nominated by the public and chosen by the panel.

USPSTF recommendations do not set policy, although they may serve as the basis for guidelines established by medical associations and insurers.

Under the Affordable Care Act, Medicare and health plans must pay for services recommended by the USPSTF. Medicare may pay for services not recommended by USPSTF if the Department of Health and Human Services so decides. Insurers may or may not reimburse for services not recommended by the USPSTF.

The Nelson team's review of the evidence regarding preventive use of HT appears in the May 28 issue of Annals of Internal Medicine.

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