Virginia A. Moyer, MD, MPH; on behalf of the U.S. Preventive Services Task Force*
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
Potential Conflicts of Interest: Disclosure forms from USPSTF members can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2392.
Requests for Single Reprints: Reprints are available from the USPSTF Web site (www.uspreventiveservicestaskforce.org).
Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation statement on hormone therapy for the prevention of chronic conditions in postmenopausal women.
The USPSTF commissioned a review of the literature to update evidence about the benefits and harms of using menopausal hormone therapy to prevent chronic conditions, as well as whether the benefits and harms of hormone therapy differ by population subgroups defined by age; the presence of comorbid medical conditions; and the type, dose, and method of hormonal delivery.
This recommendation applies to postmenopausal women who are considering hormone therapy for the primary prevention of chronic medical conditions. It does not apply to women who are considering hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness. It also does not apply to women younger than 50 years who have had surgical menopause.
The USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women. (Grade D recommendation).
The USPSTF recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. (Grade D recommendation).
Menopausal hormone therapy for the primary prevention of chronic conditions: clinical summary of U.S. Preventive Services Task Force recommendation.
Appendix Table 1.
What the USPSTF Grades Mean and Suggestions for Practice
Appendix Table 2.
Levels of Certainty Regarding Net Benefit
Estimated Event Rate Differences Associated With the Use of Oral Estrogen and Progestin in Postmenopausal Women Compared With No Treatment
Estimated Event Rate Differences Associated With the Use of Unopposed Oral Estrogen in Postmenopausal Women Without a Uterus Compared With No Treatment
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Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement And Postmenopausal Hormone Therapy: The Heart of the Matter
TO THE EDITOR:
The consensus is that best treatments are based on the results of controlled prospective blind folded studies. But what to do if the studies are imperfect and/or do not correspond with personal experience and observations? The Women’s Health Initiative (WHI) study has been criticized for enrolling older postmenopausal women for treatment with Prempro/Premarin and showing a statistically significant increase of medical problems compared to placebo takers. Women discontinued hormone replacement therapies (HRT) out of fear it would cause more serious health problems than benefits.
In 2010 the Endocrine Society scientific consensus stated that WHI study could not be applied for an assessment of all benefits and risks of HRT in women starting within a time frame less than 10 years after menopause (1). The National Osteoporosis Society concluded that HRT should play a role in the management of osteoporosis for women without risk factors under the age of 60 years (2). The Danish Osteoporosis Prevention Study (DOPS) showed that it might not be harmful to be on estrogens the first ten years after menopause (3).Testosterone in all different forms for aging men is acceptable but why not estrogens for aging females in early menopause? Women inquire about estrogen therapy and “bio-identical hormones”. This was reviewed with a much-needed practical advice. Women who start on HRT younger than 60 years of age could possibly have a 30% lower rate of death from all causes (4). The recommendations of the U.S. Preventive Services Task Force focusing on prevention of chronic conditions were not significantly different from previous recommendations and supported by a panel of highly positioned academic women in your journal. These recommendations in a strict sense could prevent estrogen treatment in the first years after menopause.
Maybe it is a matter of practical courage to admit it is not clear what is best and amend the guidelines for the first five to ten years after menopause. As a concerned practicing physician I have to advise and act to the best of my understanding of the limited data, which could be easily subjected to criticism. In the end, should it not be the individual who should decide with the help of physicians?
(1) Santen RJ, Allred DC, Ardoin SP, Archer DF, Boyd N, Braunstein GD, Burger HG, Colditz GA, Davis SR, Gambacciani M, Gower BA, Henderson VW, Jarjour WN, Karas RH, Kleerekoper M, Lobo RA, Manson JE, Marsden J, Martin KA, Martin L, Pinkerton JV, Rubinow DR, Teede H, Thiboutot DM, Utian WH: Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab 2010 Jul; 95 (7 Suppl 1): 1-66.
(2) Bowring CE, Francis RM: National Osteoporosis Society’s Position Statement on hormone replacement therapy in the prevention and treatment of osteoporosis. Menopause Int. 2011 Jun; 17 (20): 63-5.
(3) Mosekilde L, Hermann AP, Beck-Nielsen H, Charles P, Nielsen SP, Sorensen OH The Danish Osteoporosis prevention Study (DOPS): Project design and inclusion of 2000 normal perimenopausal women. Marturita 1999: 31:207-19.
(4) Pattimakiel L, Thaker H: Bioidentical hormone therapy: Clarifying the misconceptions: Cleveland Journal of Medicine Vol. 78 (12) December 2011: 829-836.
Moyer VA, on behalf of the U.S. Preventive Services Task Force*. Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2013;158:47-54. doi: 10.7326/0003-4819-158-1-201301010-00553
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Published: Ann Intern Med. 2013;158(1):47-54.
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