Putting Prevention into Practice
An Evidence-Based Approach
Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women
Am Fam Physician. 2018 Apr 15;97(8):541-542.
D.M. is a 52-year-old woman who presents to your office for a well-woman visit. She has been menopausal since 50 years of age and has no significant medical or surgical history. She is up to date on her recommended screenings, with normal mammography and colonoscopy results, and has no history of an abnormal Papanicolaou test result. She reports no menopausal symptoms.
Case Study Questions
1. According to the U.S. Preventive Services Task Force (USPSTF), there is convincing evidence that the use of combined estrogen and progestin is associated with an increased risk of which of the following conditions?
A. Invasive breast cancer.
B. Venous thromboembolism.
C. Coronary heart disease.
D. Diabetes mellitus.
2. D.M. asks whether she should take hormone therapy with combined estrogen and progestin to reduce her risk of chronic conditions. According to the USPSTF, which one of the following statements is correct?
A. D.M. should not take hormone therapy to prevent chronic conditions because it will increase her risk of colorectal cancer.
B. There is insufficient evidence to determine whether D.M. should take hormone therapy to prevent chronic conditions.
C. D.M. should not take hormone therapy to prevent chronic conditions because it has no net benefit in most postmenopausal women.
D. D.M. should take hormone therapy to reduce her risk of fractures and urinary incontinence.
E. D.M. should take hormone therapy to reduce her risk of developing dementia.
3. If D.M. had previously undergone hysterectomy, which one of the following statements would be most appropriate?
A. Estrogen alone has no net benefit for the primary prevention of chronic conditions in most postmenopausal women who have had a hysterectomy.
B. There is insufficient evidence to determine if estrogen alone has a net benefit for the primary prevention of chronic conditions in most postmenopausal women who have had a hysterectomy.
C. Estrogen alone is recommended for the primary prevention of chronic conditions in
1. US Preventive Services Task Force. Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: US Preventive Services Task Force recommendation statement. JAMA. 2017;318(22):2224–2233.
2. Gartlehner G, Patel SV, Feltner C, et al. Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;318(22):2234–2249.
See related AFP Community Blog post at http://afpjournal.blogspot.com/2017/10/is-short-term-hormone-replacement.html.
This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/menopausal-hormone-therapy-preventive-medication1.
This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.
A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.
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