Case Study

A 50-year-old woman presents for an initial wellness visit at your practice. She reports being in good health. During the interview, she explains that she researched menopause when she began having more time and variability between her menstrual cycles. She read that several diseases become more common after menopause. She reports discussing menopause with her mother, who says that she took hormone therapy when she started menopause. The patient asks whether she would benefit from hormone therapy to prevent the onset of chronic conditions. Her last menstrual cycle was more than one year ago.

Case Study Questions

1. According to the U.S. Preventive Services Task Force (USPSTF) recommendation on hormone therapy for the primary prevention of chronic conditions in postmenopausal people, which one of the following statements is correct for this patient?

• A. Hormone therapy should be recommended for postmenopausal people because it is associated with a decreased risk of coronary heart disease.

• B. Use of combined estrogen and progestin therapy should be recommended in postmenopausal people because it is associated with a decreased risk of diabetes mellitus.

• C. Hormone therapy should not be used for the prevention of chronic conditions in postmenopausal people because there is insufficient evidence to weigh the benefits and harms.

• D. Hormone therapy should not be used for the prevention of chronic conditions in postmenopausal people because there is no net benefit.

2. According to the USPSTF recommendation on hormone therapy for the primary prevention of chronic conditions in postmenopausal people, which one of the following risks is increased when taking hormone therapy?

• A. All-cause mortality.

• B. Colorectal cancer.

• C. Urinary incontinence.

• D. Diabetes.

• E. Fractures.

Answers

1. The correct answer is D. The USPSTF recommends against using hormone therapy with either combined estrogen and progestin or estrogen alone for the primary prevention of chronic conditions in postmenopausal people who have had a hysterectomy.¹ The USPSTF reviewed the evidence on the benefits and harms of hormone therapy and concluded with moderate certainty that there is no net benefit for the primary prevention of chronic conditions. The USPSTF noted that although chronic conditions (e.g., cardiovascular disease, cancer, osteoporosis, fractures) increase in prevalence and incidence with age, the excess risk attributable to menopause alone is uncertain. The USPSTF found adequate evidence that the use of hormone therapy does not have a beneficial effect on the risk of coronary heart disease. The USPSTF concluded that although combined estrogen and progestin is associated with a decreased risk of diabetes, it does not recommend hormone therapy for chronic disease prevention because the overall benefits do not outweigh the harms.

2. The correct answer is C. The USPSTF found adequate evidence that the use of hormone therapy is associated with an increased risk of urinary incontinence compared with placebo.² The USPSTF found no significant difference in all-cause mortality among individuals receiving hormone therapy replacement compared with those receiving placebo. The USPSTF found that the use of hormone therapy (both combined estrogen and progestin and estrogen alone) is associated with a reduced risk of fractures and diabetes, and use of combined estrogen and progestin is associated with a reduced risk of colorectal cancer compared with placebo.

The views expressed in this work are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. government.