Panel Advises Against Hormones to Prevent Disease
Oct. 22, 2012 -- An influential panel of government advisors says hormone replacement therapy shouldn’t be prescribed to women after menopause to stave off chronic medical conditions like heart disease or osteoporosis.
After considering the latest scientific evidence, the U.S. Preventive Services Task Force (USPSTF) reaffirmed its previous guideline on hormone replacement therapy (HRT), which was published in 2005.
The panel agreed that although HRT has benefits, like reducing the risk of broken bones in postmenopausal women, increased risks tied to its use outweigh any benefit for chronic conditions.
The statement confirms a sea change in medical thinking on hormones. A decade ago, doctors called an early halt to a landmark study called the Women’s Health Initiative (WHI) after finding that women taking hormones had more heart attacks, strokes, and cancers than their peers who were taking placebo pills.
Almost overnight, millions of women stopped taking hormones, which had been thought to prevent many of the very diseases studies have now shown that they increase risk for.
After reviewing the findings from nine trials that looked into the effectiveness of hormone therapy for prevention of chronic conditions, the panel concluded that women who take hormones after menopause are more likely than those who do not to get breast cancer, blood clots in the legs and lungs, strokes, heart attacks, dementia, gallbladder disease, and urinary incontinence.
The new guideline, published in the Annals of Internal Medicine, applies to both the use of estrogen alone or in combination with progestin.
Importantly, because the USPSTF doesn’t tackle issues related to treatment, the recommendation does not speak to the estimated 20% of women who take hormones for a short time to quell menopausal symptoms like hot flashes and vaginal dryness. It also does not speak to younger women under the age of 50 who have menopause due to surgical removal of the ovaries.
“The frame for the Task Force for every recommendation we make is what is safe and effective to do in people who don’t have symptoms who are just trying to prevent things for the future,” says panel member Kirsten Bibbins-Domingo, PhD, MD, an associate professor of medicine and epidemiology at the University of California, San Francisco.
“When you’re taking something to actually treat something, that balance,” of risks and benefits, “might be different,” Bibbins-Domingo says.
“Nothing about our guidelines is meant to replace a woman’s conversation with her doctor,” she says.
Recent studies suggest that women who take HRT around the time of menopause may be able to safely relieve symptoms without increased risks of cancer and heart disease that are seen in women who start hormones when they are well past menopause.
“Younger women may actually have a benefit, and certainly they don’t have the same risk,” says Michael Nimaroff, MD, vice chairman and chief of gynecology at North Shore University Hospital in Manhasset, N.Y.
Other experts agree.
“I agree with the USPSTF guidelines that hormone therapy should not be used for chronic disease prevention,” says JoAnn E. Manson, MD, DrPH, chief of the division of preventive medicine at Brigham and Women's Hospital in Boston.
“The pendulum has swung to the more appropriate place of hormone therapy reserved for the treatment of menopausal symptoms,” Manson says.