Hormone Therapy Good for Prevention of Chronic Conditions
In the United States, the average lifespan for a woman who reaches menopause is an additional 3 decades. During that time, the estimated risk for the development of a chronic medical condition is approximately 30% for coronary heart disease, 22% for dementia, 21% for stroke, 15% for hip fracture, and 11% for breast cancer.
The objective of this 2012 update of the 2005 US Preventive Services Task Force (USPSTF) recommendation statement on hormone therapy was to update evidence and recommendations about the benefits and harms of menopausal hormone therapy when used to prevent chronic conditions, based on a review of the literature.
To learn more about the updated USPSTF statement on menopausal hormone therapy, Medscape Education interviewed Michael LeFevre, MD, MSPH. Dr. LeFevre serves as the vice co-chair of the task force and is a Future of Family Medicine professor and vice chair of the Department of Family and Community Medicine at the University of Missouri, Columbia.
STUDY HIGHLIGHTS
The USPSTF commissioned a literature review to update evidence regarding the benefits and harms of menopausal hormone therapy when used to prevent chronic conditions.
This review also examined whether subgroups defined by age; the presence of medical comorbidities; and the type, dose, and mode of hormonal delivery differed in the benefits and harms of hormonal therapy.
The USPSTF found convincing evidence that estrogen and progestin therapy is of moderate benefit in reducing the risk for fractures in postmenopausal women.
However, the USPSTF 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.
The current USPSTF recommendation is intended for postmenopausal women who are considering hormone therapy for the primary prevention of chronic medical conditions.
The current USPSTF recommendation is not intended for women who are considering using hormone therapy to treat hot flashes, vaginal dryness, or other menopausal symptoms; nor is it intended for women younger than 50 years who have undergone surgical menopause.
The USPSTF has issued a D recommendation against the use of combined estrogen and progestin to prevent chronic conditions in postmenopausal women.
The USPSTF has issued a D recommendation against the use of estrogen alone to prevent chronic conditions in postmenopausal women who have undergone hysterectomy.
A D recommendation means that the USPSTF recommends against the service, because moderate or high certainty exists that the service has no net benefit or that the harms outweigh the benefits.
The USPSTF did not review the evidence related to a possible indication for the use of hormone therapy to treat menopausal symptoms, such as hot flashes or vaginal dryness, because this falls outside of the mission and scope of the USPSTF.
The use of hormonal therapy to prevent chronic conditions in postmenopausal women is associated with several potential benefits, but there are also substantial, well documented harms to consider.
The USPSTF characterized the magnitude of adverse consequences associated with postmenopausal hormone therapy as being moderate.
The USPSTF characterized the benefits of postmenopausal hormone therapy as small in the case of combined estrogen and progestin therapy and small to moderate in the case of estrogen alone.
Therefore, the USPSTF concluded with high certainty that there is zero to negative net benefit from the use of combined estrogen and progestin therapy to prevent chronic conditions and concluded with moderate certainty that there is no net benefit from the use of estrogen alone.
It is important to state this current recommendation does not apply to women interested in using hormone therapy for the management of menopausal symptoms. It is only for the prevention of chronic diseases.
Ann Intern Med. 2013;158:47-54.
via Blogger http://chiropractic-lane.blogspot.com/2013/08/hormone-therapy-good-for-prevention-of.html
Recent Comments