Hormone Therapy Risks Outweigh Benefits

May 29, 2012 Updated: October 1, 2015
An elderly woman walks in San Jose
An elderly woman walks in San Jose on May 12. (RODRIGO ARANGUA/AFP/GettyImages)

Women past menopause should not take hormone replacement therapy (HRT) due to increased risk of disease, says a recent statement by a panel of preventive medicine experts.

The U.S. Preventive Services Task Force (USPSTF) released a draft recommendation statement May 29 that found the potential harm of HRT, and its use of estrogen and progestin, greater than the potential benefit. The group suggests that HRT not only fails to protect against heart disease, it actually increases the risk of that and other ills.

The task force “recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women,” according to the draft statement.

Osteoporosis, a disease that causes loss of bone density and bone tissue, can be a debilitating, painful condition that impacts menopausal women over 50. Hormones were once touted as a fountain of youth, meant to keep bones strong, skin supple, brains smart, and hearts healthy.

Menopausal women over 50 have a lower risk of hip fractures and other fractures if they take hormones. “The USPSTF found convincing evidence that estrogen and progestin therapy is of moderate benefit in reducing the risk for fractures in postmenopausal women,” the USPSTF stated.

But according to the draft recommendation, the group “found adequate evidence that its use is also associated with moderate harms, including an increase in the risk for stroke, dementia, gallbladder disease, and urinary incontinence. There is convincing evidence of a small increase in the incidence of invasive breast cancer, and adequate evidence of a small increase in breast cancer deaths.”

The advice does not apply to women under 50. For them, estrogen alone can reduce the risk of breast cancer, although it is not yet understood why that is the case.

The task force used data from a Women’s Health Initiative (WHI) randomized, controlled trial, involving participants of an average age of 64—well past menopause.

Hormone replacement therapy had already fallen out of favor for post-menopausal women over evidence that it increases the risk of breast cancer.

It is possible that hormones can be safely used to help women make the transition through menopause, which can be associated with hot flashes, insomnia, and other discomforts. The task force recommends a black-box warning, advising doctors to prescribe the lowest possible dose for a limited time, for younger women than those in the trial.

Other credible sources recommend women avoid HRT altogether. “The American Heart Association and the American Congress of Obstetricians and Gynecologists recommend against the use of menopausal hormonal therapy for the primary or secondary prevention of cardiovascular disease,” said the USPSTF. “The Canadian Task Force on Preventive Health Care and the American Academy of Family Physicians recommend against the use of hormonal therapy in postmenopausal women for the prevention of chronic conditions.”

Controversy

The USPSTF has made controversial recommendations before, including fewer mammograms for women and abandoning the PSA prostate test for men, suggesting the two screenings may lead to false positives and overtreatment. The PSA is suspected of not accurately detecting prostate cancer.

The Agency for Healthcare Research and Quality (AHRQ) oversees and assists the work of the USPSTF. The task force, created in 1984, is made up of 16 volunteer members “from the fields of preventive medicine and primary care” charged with “making evidence-based recommendations about clinical preventive services,” according to the AHRQ website.

Being a draft statement, the findings are “distributed solely for the purpose of pre-release review” and do not “represent and should not be interpreted to represent an AHRQ determination or policy.”

The U.S. Preventive Services Task Force invites the public to comment on its advice until June 26.

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