The U.S. Preventive Services Task Force provides an updated evidence report and issues recommendations supporting its 2017 advice against the use of hormone therapy for the prevention of chronic conditions in postmenopausal individuals.
Evidence Report and Systematic Review: Based on findings of 20 trials of hormone therapy for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers, authors conclude that “use of hormone therapy in postmenopausal persons for the primary prevention of chronic conditions was associated with some benefits but also with an increased risk of harms.” Studies looked at the use of estrogen alone for the prevention of diabetes, fractures, gallbladder disease, stroke, venous thromboembolism, and urinary incontinence, and estrogen plus progestin for the prevention of colorectal cancer, diabetes, fractures, invasive breast cancer, gallbladder disease, stroke, venous thromboembolism, probable dementia, and urinary incontinence.
USPTF Recommendations: “The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal persons. (D recommendation)” and “against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy. (D recommendation)” These recommendations are consistent with those in the USPTF’s 2017 report.
Editorial: “With this most recent update of the USPSTF guidelines, the scientific and medical community should let go of the past,” editorialists write after asking “when is enough, enough?” “Instead of investing additional resources into trying to parse out subsets of menopausal patients who may derive some preventive benefit from [menopausal hormone therapy (MHT)] for a limited amount of time, research should focus on developing more thoughtful guidance for individual decision-making about MHT for menopausal symptoms and conducting more rigorous and extended follow-up of other medications used to treat menopausal symptoms. Strategies are also needed for starting MHT for symptom management in early menopause but then weaning down therapy when the absolute risks of other chronic diseases affected by therapy are known to increase.”