No Change in Change-of-Life Hormone Warnings

HRT not recommended for postmenopausal women

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) A decade ago, when a woman reached menopause, she likely reached for hormone replacement therapy to calm the symptoms associated with the change in life. Then a large study called the Women's Health Initiative challenged that treatment.

The use of estrogen and progestin to treat postmenopausal symptoms and prevent chronic disease is not recommended, nor is the use of estrogen alone for women who have undergone a hysterectomy.

After a decade-long literature review, the United States Preventive Services Task Force (USPSTF) has not changed its 2005 recommendations regarding hormone replacement therapy.

"Find natural alternatives for dealing with the woes of menopause."

The USPSTF commissioned a review of a total of 51 articles relating to HRT which have been published since 2002. The objective was to update evidence about the benefits and risks associated with HRT use among postmenopausal women.

The authors wrote, “The average woman in the United States who reaches menopause is expected to live another 30 years. During her remaining lifespan, the estimated risk for developing a chronic medical condition is approximately 30 percent for coronary heart disease, 22 percent for dementia, 21 percent for stroke, 15 percent for hip fracture, and 11 percent for breast cancer.”

The USPSTF confirmed its earlier recommendations against HRT because the risks outweigh the benefits. The following risk factors associated with HRT use are now well-established:

Estrogen + progestin

  • Decreases risks of bone fractures
  • Increases risk for dementia and breast cancer
  • Increases the risk of stroke, blood clotting problems, gallbladder disease and urinary incontinence (inability to hold urine)
  • Increases breast cancer risks for women who have previously taken birth control pills or other estrogen+progestin HRT or are currently smokers

Estrogen alone

  • Decreases risk for invasive breast cancer
  • Increases likelihood of stroke, blood clotting problems and gallbladder disease.
  • Does not reduce risk of coronary heart disease (CHD) 

These recommendations only apply to healthy women over the age of 50 who don’t have other risks factors for breast cancer and cardiovascular disease.

“The USPSTF has generated lots of controversy with several of its recommendations of late,” Patrick D. Maguire, MD, who was not involved in the study, told dailyRx News. 

“However, this updated recommendation about hormonal replacement therapies (HRT) for postmenopausal women should be relatively well accepted. The overwhelming evidence in the medical literature is that the cons outweigh the pros by far,” said Dr. Maguire who is a radiation oncologist in North Carolina and author of When Cancer Hits Home: An Empowered Patient is the Best Weapon Against Cancer.

These findings were published October 23 in the Annals of Internal Medicine. No funding information was provided, and no conflicts of interest were reported.

Reviewed by: 
Review Date: 
October 22, 2012
Last Updated:
October 22, 2012