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USPSTF Guidelines for HT in Postmenopausal Women

JAMA; 2017 Dec 12; US Preventive Services Task Force

The US Preventive Services Task Force (USPSTF) has issued a recommendation statement for hormone therapy for the primary prevention of chronic conditions in postmenopausal women. The guideline updates the 2012 USPSTF recommendation and determined after a review of the evidence (18 clinical trials) that although the use of hormone therapy to prevent chronic conditions in postmenopausal women is associated with some benefits, there is also a substantial increase in risk of harms. The updated recommendation statement reads:

  • The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal women (D recommendation).
  • The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal women who have had a hysterectomy (D recommendation).

Citation:

US Preventive Services Task Force. Hormone therapy for the primary prevention of chronic conditions in postmenopausal women. US Preventive Services Task Force recommendation statement. JAMA. 2017;318(22):2224–2233. doi:10.1001/jama.2017.18261.

Commentary:

Menopausal hormone therapy used to be common, with approximately 40% of women being treated with estrogens from 1988-1994. After publication of the Women’s Health Initiative (WHI), which showed postmenopausal hormone use to have serious adverse effects, the use of menopausal hormone replacement decreased, and by 2010 only 5% of women were prescribed menopausal hormone therapy.1 The use of combined estrogen and progestin reduces the risk of fractures in postmenopausal women and also reduces the risk of diabetes. It increases risk of invasive breast cancer, venous thromboembolism, and coronary artery disease. In aggregate, the harm outweighs the benefit. It is important to understand that this statement applies to asymptomatic, postmenopausal women where hormone replacement is being looked at for the primary prevention of chronic medical conditions. The recommendation against using hormone therapy does not apply to the use of perimenopausal hormone replacement for symptomatic treatment of hot flashes or vaginal dryness, nor does it apply to hormone replacement for premature ovarian failure. —Neil Skolnik, MD

  1. Gartlehner G, Patel S, Viswanathan M, et al. Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: An evidence review for the US Preventive Services Task Force: Evidence Synthesis No. 155. Rockville, MD: Agency for Healthcare Research and Quality; 2017. AHRQ publication 15-05227-EF-1.