Hormone therapy in postmenopausal women
When should hormone replacement therapy be used in postmenopausal women?
Estrogen/progestin therapy should not routinely be used to prevent chronic disease in postmenopausal women. The Task Force making this recommendation did not address short-term (1-2 years) treatment of symptoms of menopause. The risks with chronic therapy are minimal, but so are the benefits to chronic disease prevention. (LOE = 1a)
U.S. Preventive Services Task Force. Hormone therapy for the prevention of chronic conditions in postmenopausal women: Recommendations from the U.S. Preventive Services Task Force. Ann Intern Med 2005;142:855-60.
Study design: Practice guideline
Setting: Various (guideline)
The United States Preventive Services Task Force recommends against the routine use of estrogen/progestin therapy for the prevention of chronic conditions in postmenopausal women (grade D recommendation; ie, fair evidence that treatment is ineffective or potential harm outweighs potential benefit). The Task Force cites good evidence that hormone replacement reduces risk of fracture and colorectal cancer. Hormone replacement has no beneficial effect on coronary heart disease and may, in fact, increase risk. Other increased risks: breast cancer, venous thromboembolism, stroke, cholecystitis, dementia, and lower cognitive function. However, the risks are small: for every 10,000 women taking hormone replacement for 1 year, there will be 7 more events related to coronary heart disease, 8 more strokes, 8 more pulmonary embolisms, and 8 more cases of breast cancer. There will also be 6 fewer cases of colorectal cancer and 5 fewer hip fractures. Similarly, the Task Force recommends against routine use of unopposed estrogen (grade D recommendation).