By Jennifer Corbett Dooren
A federal task force has once again examined the use of hormone replacement therapy, and is again recommending against hormones for preventing fractures, dementia and other chronic diseases in women who are already past menopause.
The U.S. Preventive Services Task Force issued the draft guidelines on the use of estrogen and progestin to take into account new findings from the landmark Women’s Health Initiative study that looked at hormone use, along with other studies issued in the past decade.
The recommendations don’t apply to women who are experiencing menopause and use hormones to treat hot flashes and other symptoms.
The federally funded Women’s Health Initiative, known as WHI, was halted in 2002 when initial results showed women taking a combination of estrogen and progestin had a higher risk of breast cancer, heart disease and stroke than women who received a placebo. Although participants stopped taking hormones at that time, researchers have continued to monitor them to analyze outcomes.
In 2002, the task force issued recommendations against combination use of estrogen and progestin in post-menopausal women, and later advised against estrogen-only use in these women as well.
Dr. Kirsten Bibbins-Domingo, a task force member and an associate professor of medicine, epidemiology and biostatistics at the University of California, San Francisco, said the recommendations for post-menopausal women haven’t changed. But, she said, it was important to take a new look at the issue given the additional information that has come out in recent years. For example, one study suggested women taking estrogen-only therapy had a lower risk of invasive breast cancer.
The task force notes that the vast majority of women currently using hormone therapy are younger and transitioning through menopause. The FDA has approved hormones to prevent menopausal symptoms and to prevent fractures, according to the task force. The products carry a boxed-warning stating that estrogen with or without progestin “should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risk for the individual woman.”
As the Health Blog noted recently, much research suggests that the benefits of hormone-replacement therapy outweigh the risks for women who start it near menopause. Data from WHI suggests much of the harm seen in women was among those in their 60s and 70.
Unlike previous task force recommendations, such as one issued earlier this month advising against prostate-cancer screening with a PSA test in men, the updated recommendation on hormone-replacement therapy for postmenopausal women aren’t controversial. However, the task force is taking comments on the draft hormone therapy recommendations from now until June 26.