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Menopausal Hormone Therapy to Prevent Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement FREE

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The full report is titled “Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 1 January 2013 issue of Annals of Internal Medicine (volume 158, pages 47-54). The author is V.A. Moyer, on behalf of the U.S. Preventive Services Task Force.

This article was published at www.annals.org on 23 October 2012.

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Ann Intern Med. 2013;158(1):I-34. doi:10.7326/0003-4819-158-1-201301010-00554
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Who developed these recommendations?

The U.S. Preventive Services Task Force (USPSTF) developed these recommendations. The USPSTF is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Around menopause, the levels of the hormones estrogen and progestin decrease, resulting in hot flashes, sweats, mood swings, and vaginal dryness. Lower hormone levels are associated with bone loss and cardiovascular disease, such as heart attack or stroke.

Menopausal hormone therapy involves taking estrogen with or without progestin. Combined hormone therapy involves taking both hormones, and it is necessary in women with a uterus because estrogen alone greatly increases the risk for cancer of the uterus. Women who have no uterus because they have had a hysterectomy can take estrogen alone. Some women take hormone therapy to relieve menopause symptoms, some take it to reduce the risk for osteoporosis (thinning of the bones that can lead to fractures), and some take it because they hope it will decrease their risk for other chronic conditions.

In 2005, the USPSTF recommended against postmenopausal women taking hormone therapy (either combined therapy in women with a uterus or estrogen alone in women without a uterus) for the sole purpose of preventing chronic conditions. The USPSTF wanted to update the recommendations after reviewing new information published since 2005.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research to evaluate the benefits and harms of hormone therapy.

What did the authors find?

The USPSTF concludes with high certainty that the chronic disease prevention benefits of combined estrogen and progestin do not outweigh the harms in most postmenopausal women. Combined hormone therapy reduces the risk for fractures. However, there is evidence that its use is also associated with harms, including an increase in the risk for stroke, dementia, gallbladder disease, urinary incontinence, blood clots, and invasive breast cancer and a small increase in breast cancer deaths. It does not seem to protect against cardiovascular disease.

The USPSTF concludes with moderate certainty that the chronic disease prevention benefits of estrogen alone are unlikely to outweigh the harms in most postmenopausal women who have had a hysterectomy. Estrogen alone prevents fractures and also results in a small reduction in the risk for developing or dying from invasive breast cancer. However, it is also associated with harms, including stroke, gallbladder disease, urinary incontinence, and blood clots. Estrogen alone does not seem to have a beneficial effect on cardiovascular disease.

What does the USPSTF recommend that patients and doctors do?

The USPSTF recommends against postmenopausal women taking combined hormone therapy for the sole purpose of preventing chronic conditions.

The USPSTF recommends against postmenopausal women who have had a hysterectomy taking estrogen alone for the sole purpose of preventing chronic conditions.

What are the cautions related to these recommendations?

Women considering taking hormone therapy for menopause symptoms should discuss the potential benefits and risks with their doctors.





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