ROCKVILLE, MarylandAn independent advisory board has entered the debate
over the safety and efficacy of hormonal replacement therapy (HRT) and
recommended against the use of the estrogen/progestin combination in
postmenopausal women as a preventive treatment for cardiovascular disease and
other chronic conditions. It also concluded that insufficient evidence exists
to support a recommendation for or against the use of estrogen alone for
preventing chronic conditions in postmenopausal women who have undergone a
In its assessment, The US Preventive Services Task Force (USPSTF) reported
that HRT increases a woman’s risk of developing several hormone-related
cancers, while lowering the risk of colorectal cancer. It found fair evidence
that HRT increases the risk of cholecystitis.
The panel found good evidence that HRT increases bone mineral density and
fair-to-good evidence that it reduces the risk of fractures. It found
insufficient evidence for a beneficial effect of HRT on dementia or cognitive
The task force made its recommendation after reviewing the current medical
literature on HRT, including the Women’s Health Initiative (WHI) trial that
found an increased risk of breast cancer with the use of estrogen and
progestin. That arm of the WHI has been canceled.
The literature review was contained in a report prepared by Heidi Nelson,
MD, and Linda Humphrey, MD, two researchers at the Agency for Healthcare
Research and Quality (AHRQ) Evidence-based Practice Center at the Oregon
Health & Science University, Portland. The task force consists of
nongovernment experts in primary care who make recommendations for clinical
The task force did not address HRT’s role in treating menopausal symptoms.
It recommended that women using or considering using hormonal therapy for
menopausal symptoms discuss their individual risks with their physician.
"These recommendations reflect the scientific evidence concerning the
long-term effects of HRT, but there are no easy answers for women," said
USPSTF chairman Alfred Berg, MD, professor and chair of family medicine,
University of Washington. "It is, therefore, especially important that women
talk to their clinicians to decide what is best for them."