USPSTF Issues Final Recommendations Against Hormone Therapy

The U.S. Preventive Services Task Force (USPSTF) has issued its final recommendations against using menopausal hormone therapy to prevent chronic conditions in postmenopausal women.

Similar to its June draft recommendation, the task force restates the AAFP's current position, recommending against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women, as well as the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.

USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., a family physician from Columbia, Mo., said that, as a preventive strategy, the benefits of hormone therapy for this subset of women do not seem to outweigh the harms. He said the evidence regarding combination estrogen/progestin or estrogen therapy increasing the risk of stroke, thromboembolic events, gallbladder disease, and urinary incontinence continues to grow. The data also indicate estrogen plus progestin increases the risk for breast cancer and probable dementia, whereas estrogen alone decreases the risk for breast cancer.

"This recommendation applies to postmenopausal women who are considering hormone therapy for the primary prevention of chronic medical conditions," LeFevre said. "It does not apply to women who are considering using hormone therapy for the management of menopausal symptoms. This recommendation also does not apply to women younger than age 50 years who have undergone surgical menopause."

The new recommendations were compiled from a review of 51 full-text articles from nine trials, as well as one additional article that was published after the original literature search and redrafted as part of the USPSTF's normal procedure.