Hormone replacement therapy just been a confusing topic for many menopausal women. Now there's a new governmental report that adds more fuel to the debate. This new report from the U.S. Preventive Services Task Force (USPSTF) is recommending that postmenopausal women should not take hormone therapy in order to prevent chronic conditions.
This particular study reviewed results from the Women’s Health Initiative (WHI), a 10-year study of nearly 70,000 women, related to postmenopausal women who were eligible for hormone therapy. Based on their analysis, the researchers found both benefits and risks in relation to hormone therapy. For instance, the use of combined estrogen and progestin is believed to reduce the risk for fracture and colorectal cancer in postmenopausal women. However, this combination did not have a beneficial effect on and may actually increase the risk of coronary heart disease. This type of hormone therapy also may increase the risk of breast cancer, venous thromboembolism (blood clots that could lead to pulmonary embolisms), stroke, cholecystitis (inflammation of the gallbladder), dementia and lower cognitive function. Because of these findings, the USPTF gave a rating of “D” which means that it recommends against routinely providing this treatment to asymptomatic patients since it found fair evidence that the therapy is ineffective or that harms outweigh the benefits.
The task force also gave a rating of a “D” for the use of estrogen only in the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. The USPTSF reported that it found the use of estrogen helped these postmenopausal women reduce the risk for fracture; however, it also increased the risk for venous thromboembolism, stroke, dementia and lower cognitive functioning. Furthermore, the researchers identified fair evidence that this type of therapy had no beneficial effect on coronary heart disease. They also found insufficient evidence to be able to assess the effects of estrogen therapy on breast cancer, ovarian cancer and colorectal cancer, as well as breast cancer mortality and all-cause mortality. Again, the task force concluded that the risks outweighed the benefits in relation to this treatment.
The researchers also reported that age made a difference in the level of risks. The analysis found that women who went through menopause 20 years earlier or who were 70 years old or above had the highest risk of chronic conditions when they underwent hormone replacement therapies. Younger women had the lowest risk, although the differences between the risks experienced by these groups of women were not statistically significant.
However, the task force did not consider the use of these treatments over short periods of time to deal with hot flashes, vaginal dryness or other symptoms of menopause. Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston, told ABC News, “For newly menopausal women who have these symptoms and are in generally good health the benefits of treatment are likely to outweigh the risks.”
So in reality, this report just reiterates what the panel recommended in 2005. But it’s good to see this update. Everything I hear and read from experts says that if you need hormone replacement therapy, work with your doctor to take the lowest dosage that is helpful for the shortest time possible. The ABC News story notes that the current recommendation is that women should not take hormone replacement therapy for more than five years.
So what should you do if you’re a postmenopausal woman who is worried about getting one of these chronic diseases? Start with less-risky changes to your lifestyle that can help prevent these health issues. The best quote I’ve seen came from Dr. Ranit Mishori, an associate professor at Georgetown University School of Medicine. In response to this study's findings, he told ABC News the following: “There are no magic pills or magic bullets. Get off your butt, eat a healthy diet, don’t smoke and lead a healthy lifestyle. If it’s post-menopausal symptoms that bother you, talk to your doctor about short-term treatment with HRT.”
Primary Sources for This Sharepost:
Gann, C. (2012). Menopause therapy benefits hit in govt report. ABC News.
U.S. Preventive Services Task Force. (2012). Hormone replacement therapy for the prevention of chronic conditions in postmenopausal women.
Published On: May 30, 2012