Task force issues review, draft recommendations against hormone therapy for primary prevention

The U.S. Preventive Services Task Force (USPSTF) has reviewed the latest evidence on using menopausal hormone therapy for primary prevention of chronic disease and has issued draft recommendations.

The systematic review, which was published online by Annals of Internal Medicine on May 28, included randomized, controlled trials published between 2002 and late 2011 that focused on hormone therapy for primary prevention. In total, nine trials, including the Women's Health Initiative (WHI), met the criteria. The use of hormone therapy to treat menopausal symptoms was outside the scope of the review, the study authors noted.

After reviewing the trials, researchers concluded that estrogen taken with progestin and estrogen alone were both associated with reduced fracture risk but increased risk for stroke, thromboembolism, gallbladder disease and urinary incontinence. Estrogen plus progestin also increased the risk of breast cancer and dementia. However, estrogen alone decreased the risk of breast cancer.

The updated data from the WHI used in this analysis differ from initial findings, the reviewers noted. Follow-up data from the trial showed that the hormones' effect on breast cancer risk had become significant, while a decrease in colorectal cancer and an increase in coronary heart disease found with estrogen and progestin were no longer statistically significant.

Based on the review, the USPSTF issued two draft recommendations. It recommended against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women and against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.

The task force noted that the recommendations apply to postmenopausal women considering hormone therapy for the primary prevention of chronic medical conditions, not women younger than age 50 years who have undergone surgical menopause or those considering hormone therapy for the management of menopausal symptoms. The recommendations are open for comment until June 26.