ROCKVILLE, Maryland—An 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 hysterectomy.
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 dysfunction.
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 preventive services.
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."
