Latest Guidelines: Should Postmenopausal Women Use Hormone Therapy to Prevent Chronic Conditions?

Hormone therapy was previously prescribed for post-menopausal women to help prevent certain chronic conditions, such as heart disease and breast cancer. It was thought that these diseases, which are more common with increasing age, were connected to the hormonal changes that take place during menopause. But new information has reversed recommendations about using hormonal therapy for chronic disease prevention.

A change in recommendations

In the past, hormone therapy was thought to prevent chronic health conditions like heart disease, dementia, stroke, and breast cancer for postmenopausal women. It is accepted that these diseases are more common with age, but what wasn’t certain was whether menopause contributed to the rate of disease and whether estrogen therapy could help with prevention.

A report released by a government-backed panel in December 2017 indicates that the risk of significant side effects from hormonal therapy outweigh any possible benefit and that there is no clear evidence that there are benefits or that these diseases are linked to the hormonal changes of menopause.

The government-backed panel, called the U.S. Preventative Services Task Force (USPSTF), reviewed 18 studies, which involved more than 40,000 women.

They found that there were some possible benefits of hormonal therapy:

• Potential moderate benefit for reducing risk of bone fractures
• Possible small benefit for reducing risk of colon cancer and diabetes

However, they also found there were also substantially increased side effects:

• Might increase risk of breast cancer
• Increased risk of blood clots
• May be some increased risk of heart disease, stroke, dementia, gallbladder disease, and urinary incontinence

The task force concluded that “hormone therapy has no net benefit for prevention of chronic medical conditions in most postmenopausal women.” Instead, they recommend a healthy diet and physical activity to prevent heart disease, low-dose aspirin to decrease the risk of colon cancer and cardiovascular disease, and medications such as tamoxifen and raloxifene to decrease the risk of breast cancer in those with certain high-risk factors.

What hasn’t changed

Symptoms of menopause include tiredness, problems sleeping, mood disturbances, night sweats, hot flashes, and vaginal dryness. When these symptoms interfere with daily functioning, doctors can prescribe hormonal therapy, estrogen and progesterone, to provide relief.

The task force looked at the effects of short-term hormonal treatment for the symptoms of menopause and did not find higher risks of cardiovascular disease or cancer. Therefore, they did not see any reason for women to discontinue using the hormonal treatment for relief of night sweats, vaginal dryness, hot flashes, or other menopausal symptoms.

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