Post-Menopausal Women Should Not Take Hormone Therapy to Prevent Chronic Conditions – Everyday Health

In new draft guidelines, the U.S. Preventive Services Task Force (USPSTF) recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in post-menopausal persons, including those who have had a hysterectomy.

The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine, per its website.

The current draft is consistent with the most recent USPSTF statement, from 2017, which recommended against the use of hormone replacement therapy (HRT) for primary prevention of chronic conditions. Nothing has changed, says Stephanie S. Faubion, MD, an internal medicine doctor at the Mayo Clinic in Rochester, Minnesota, and the medical director of the North American Menopause Society, and not a member of the task force.

Currently, hormone therapy is recommended only for the treatment of vasomotor symptoms, and its been approved by the FDA [U.S. Food and Drug Administration] for the prevention of bone loss, though its not recommended for the treatment of osteoporosis, says Dr. Faubion.

To update the recommendation statement from five years ago, committee members reviewed data from 20 fair- or good-quality trials and three large controlled cohort studies on the effectiveness of hormone therapy for reducing the risk of chronic conditions among post-menopausal women. They reported the following findings:

The draft evidence review and recommendation statement have been posted for public comment, and comments can be submitted from April 19 to May 16, 2022.

The recommendations are aligned with those of the North American Menopause Society (NAMS), which advises that hormone therapy not be prescribed for chronic disease prevention. The American College of Obstetricians and Gynecologists also recommends against the use of menopausal hormone therapy for primary or secondary prevention of coronary heart disease, though it can be appropriate for some women to relieve menopause symptoms or for women with an increased risk of osteoporosis and fracture, per the group.

According to the USPSTF, more research is needed to address knowledge gaps in the following areas:

Hormone therapy was extremely popular for several years, but its use plummeted in 2002 after the first results of the Womens Health Initiative showed that therisks of HRT outweighed the benefits.

Menopausal women need to be aware of what hormone therapy can and cant do, says Faubion. Is it going to prevent chronic disease, is it a fountain of youth that prevents aging, or can it help you lose weight? We dont have evidence that hormone therapy does any of those things, she says.

But the majority of women who might benefit from hormone therapy arent on it, says Faubion. That would include women with menopause symptoms such as hot flashes, night sweats, and vaginal dryness who are under the age of 60 and within 10 years of the menopause transition, she says. I think we need to get back to embracing it as a potential choice for those women, says Faubion.

The USPSTF recommendations arent meant to instruct women who are trying to decide whether HRT is the right choice for them as an individual, says Margaret Nachtigall, MD, a gynecologist at NYU Langone Health and a clinical assistant professor at the NYU School of Medicine, both in New York City, who was not part of the USPSTF committee.

This position statement tries to examine the advantages and disadvantage of estrogen and estrogen plus progesterone treatment; however, it does not take into consideration the individual or the individuals risk factors for developing heart disease, bone loss, and memory dysfunction, nor does it consider menopause symptoms, says Dr. Nachtigall, adding, The decision as to whether to begin estrogen treatment should be tailored to the individual, not made on a general basis.

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Post-Menopausal Women Should Not Take Hormone Therapy to Prevent Chronic Conditions - Everyday Health

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