Panel: Hormone Therapy Not for Disease Prevention

Panel: Hormone Therapy Not for Disease Prevention

Panel: Hormone Therapy Not for Prevention of Chronic Conditions

May 29, 2012 -- Women should not use hormone therapy (HT) to prevent chronic conditions, such as bone loss, after menopause.

The advice is the draft recommendation of the U.S. Preventive Services Task Force (USPSTF). It does not apply to women using hormone therapy to treat menopausal symptoms such as hot flashes.

"We are just looking at women without symptoms who are trying to prevent something bad from happening in the future," the leader of the task force's HT analysis, Kirsten Bibbins-Domingo, MD, PhD, tells WebMD. Bibbins-Domingo is associate professor of medicine at the University of California, San Francisco.

The task force made its recommendation after reviewing an analysis of the latest HT research by Heidi D. Nelson, MD, MPH, and colleagues at Oregon Health Science University.

"The last time the task force looked at this, they discouraged use of HT for any chronic condition," Nelson tells WebMD. "And in the real world, there may be some women who took HT for menopausal symptoms and are wondering whether to stay on it. These findings really apply to using HT after the symptoms of menopause are over."

The updated analysis relies heavily on the now-famous Women's Health Initiative (WHI) study in which older, mostly postmenopausal women received either a placebo or HT. In that trial, treated women got a form of estrogen called conjugated equine estrogen (CEE, derived from horse urine) plus progestin. Women who had undergone hysterectomy received estrogen (CEE) alone.

Benefits of Hormone Therapy to Prevent Disease

Hormone therapy clearly had some benefits in preventing chronic conditions. Women getting estrogen plus progestin had:

• Fewer fractures
• A lower risk of diabetes

Women getting estrogen alone had:

• Fewer fractures
• A lower risk of invasive breast cancer
• A lower risk of breast cancer death

Harms of Hormone Therapy to Prevent Disease

But hormone therapy had clear harms as well. Women getting estrogen plus progestin had:

• Higher risk of invasive breast cancer
• Higher risk of breast cancer death
• Higher risk of stroke
• Higher risk of blood clots in the leg (DVT)
• Higher risk of blood clots in the lung
• Higher risk of gallbladder disease
• Higher risk of dementia
• Higher risk of urinary incontinence
• Higher risk of lung cancer death

Women getting estrogen alone had:

• Higher risk of stroke
• Higher risk of blood clots in the leg (DVT)
• Higher risk of gallbladder disease
• Higher risk of urinary incontinence

"On balance, weighing the benefits against the harms led us to say we would not use these therapies for the prevention of chronic conditions," Bibbins-Domingo says. "It really doesn't work for most of the conditions we considered. And for the biggest benefit, osteoporosis, the harms far outweigh that benefit."

The panel took into account the fact that other effective ways to prevent osteoporosis are available.