Rockville, MD—There’s no question that prevalence and incidence of most chronic and other health conditions—coronary heart disease, dementia, stroke, fractures, and breast cancer, for example—increase with age. With menopause occurring at an average age of 51.3 years, the role of declining hormones in promoting those diseases has long been debated.

In updated recommendations, however, the U.S. Preventive Services Task Force (USPSTF) advises against the use of combined estrogen and progestin in postmenopausal women, or estrogen alone in postmenopausal women who have had a hysterectomy, to prevent chronic conditions such as heart disease, dementia, and stroke.

Part of the reason for that decision, according to the report in JAMA, is that “the excess risk for these conditions that can be attributed to menopause alone is uncertain.”

Decades ago, hormone therapy was seen as having promise in helping women avoid some of the chronic conditions associated with aging. The report points out, however, “Since the publication of findings from the Women’s Health Initiative (WHI) that hormone therapy use was associated with serious adverse health effects in postmenopausal women, use of menopausal hormone therapy has declined, from 44% of U.S. women using or having used hormone therapy in 1988-1994 to 4.7% of women in 2010.”

The USPSTF routinely makes recommendations about the effectiveness of preventive- care services, including this update from previous advice issued in 2012.

To reach its conclusions, the USPSTF reviewed the evidence on the benefits and harms of systemic hormone therapy—oral or transdermal—for the prevention of chronic conditions in postmenopausal women. It also looked at whether outcomes vary among women in different subgroups or by timing of intervention after menopause. 

While some benefits were uncovered, the USPTF also determined some harms, ultimately deciding that the magnitude of both advantages and disadvantages of hormone therapy in postmenopausal women is small to moderate. 

“Therefore, the USPSTF concluded with moderate certainty that combined estrogen and progestin has no net benefit for the primary prevention of chronic conditions for most postmenopausal women with an intact uterus and that estrogen alone has no net benefit for the primary prevention of chronic conditions for most postmenopausal women who have had a hysterectomy,” according to the report.

The group also cautioned that their advice is based on evidence alone, adding, “Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.”
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