The U.S. Preventive Services Task Force has issued a draft recommendation against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women, as well as the use of estrogen for the prevention of chronic conditions in postmenopausal women who had a hysterectomy.
The task force gave both draft recommendations a D grade, and the recommendations are consistent with the task force's final recommendation back in 2012.
“It’s important to note that this draft recommendation applies only to women who have gone through menopause and are considering hormone therapy to prevent chronic conditions,” Ann E. Kurth, PhD, CNM, MSN, MPH, task force member and dean, Yale School of Nursing, said in the release. “It does not apply to women who are considering hormone therapy to manage menopausal symptoms, such as hot flashes or night sweats.”
The release also stated that the draft recommendation does not apply to women younger than age 50 who have experienced premature menopause or who have had their ovaries surgically removed prior to menopause.
The task force “found convincing evidence” that combining estrogen and progestin is associated with moderate harms such as venous thromboembolism and invasive breast cancer; a small-to-moderate harm of increased risk for coronary heart disease; and “adequate evidence” of moderate harms, such as increased risk for urinary incontinence, gallbladder disease, dementia and stroke, according to the draft recommendation statement.
In addition, the task force “found adequate evidence” that estrogen use alone is associated with moderate harms, including an increase in the risk for venous thromboembolism, urinary incontinence, gallbladder disease, dementia and stroke.
According to the task force, guidelines from both the American Congress of Obstetricians (ACOG) and Gynecologists and the American Association of Clinical Endocrinologists note that hormone therapy is approved for women at increased risk for osteoporosis and fracture. In addition, the task force stated that the ACOG guidelines also mention the uncertainty about whether potential cardiovascular benefits for women may differ based on early vs. late initiation of hormone therapy. The task force stated that no current guidelines recommend the routine use of hormone therapy for primary or secondary prevention of heart disease, and most recommend against the use of hormone therapy for prevention of any chronic conditions.
The new draft statement and evidence review has been posted for public comment on the USPSTF website, at www.uspreventiveservicestaskforce.org. Such input will be accepted through June 12 at www.uspreventiveservicestaskforce.org/tfcomment.htm. – by Janel Miller
Healio Family Medicine was unable to determine Kurth’s relevant financial disclosures prior to publication.