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USPSTF Recommends Against Hormone Therapy to Prevent Chronic Conditions

In its latest recommendations, the USPSTF considers recently published evidence from the Women's Health Initiative.

The third U.S. Preventive Services Task Force (USPSTF) has been releasing new and updated guidelines periodically (guidelines homepage). USPSTF 3 concludes each of its guidelines with a recommendation, graded as follows:

A — The intervention is strongly recommended.

B — The intervention is recommended.

C — The USPSTF makes no recommendation for or against the intervention.

D — The intervention is not routinely recommended.

I — Evidence is insufficient to recommend for or against the intervention.

In 2002, the USPSTF recommended against the use of combination hormone therapy (HT) to prevent chronic conditions, drawing data in part from the Women's Health Initiative (WHI) randomized trial (Journal Watch Nov 22 2002). In a new statement, the task force considers more recently published evidence from the WHI. The USPSTF recommends against the routine use of either combined estrogen/progestin or unopposed estrogen for the prevention of chronic conditions in postmenopausal women. Recommendation: D

The task force identified good evidence that HT decreased fracture risk (but also noted that effective alternatives exist for this indication). There was fair evidence that combination HT reduced colorectal cancer; however, its harms include increased risks for breast cancer, venous thromboembolism, stroke, cholecystitis, dementia, and, possibly, coronary heart disease. Unopposed estrogen increases risks for venous thromboembolism, stroke, and dementia. Neither combination HT nor unopposed estrogen decreased coronary heart disease risk.

Comment: This is not a case of insufficient evidence leading to a recommendation against action. In the case of postmenopausal HT, the USPSTF found evidence showing that the harms outweigh the benefits for chronic disease prevention. Other USPSTF guidelines address options for preventing heart disease, osteoporosis, and other chronic diseases. Treatment of perimenopausal symptoms with HT was not addressed by this guideline. At the time of publication, the full text of the recommendation statement and the summary of evidence was available free of charge.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine June 14, 2005

Citation(s):

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 May 17; 142:855-60.

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