A government group is advising women to use hormone replacement therapy (HRT) to treat symptoms of menopause for only short periods of time.
The U.S. Preventive Services Task Force (USPSTF), an independent group of health experts convened at the request of Congress, first hinted that HRT may be too risky for long term use in 2005. At that time, after reviewing the available data, the task force warned women against relying on HRT to prevent chronic conditions like heart disease and dementia. Some earlier studies had suggested that the supplemental hormones that women take to relieve night sweats and hot flashes associated with menopause could also protect the heart and brain from aging-related decline.
But use of hormone therapy declined after a 2002 Women’s Health Initiative (WHI) study found little difference in rates of heart disease among women who used HRT and those who did not. Instead, it reported HRT may increase the risks of heart disease and breast cancer.
In its most recent analysis, published online in the Annals of Internal Medicine, the USPSTF confirmed its previous findings that the risk of HRT outweigh its potential benefits. The task force made its final recommendation based on a review of 51 additional studies published since 2002. Overall, the data show that HRT, which combines estrogen and progestin, is linked to increased risk of stroke, blood clots, gallbladder disease, urinary incontinence, dementia and breast cancer. Even among women who have had a hysterectomy, and therefore only need to take estrogen and not progestin to protect endometrial tissue, the risks remained significant.
The only benefits of HRT the USPSTF found outside of relieving menopause symptoms was a lower risk of fractures. But the risks far outweighed this improvement, the task force concluded. So for women at average-risk of heart disease or breast cancer, which make up the majority of those who might take HRT during menopause menopause, the panel recommends against long-term use of the hormones. For those who need immediate relief of menopausal symptoms, however, short term use of the hormones can be helpful and relatively safe. That practice is supported by a recent study published in the British Medical Journal that found estrogen-only hormone therapy shortly after menopause doesn’t result in an increase in heart risks.
Still, this recommendation isn’t likely to be the final word on HRT. The task force says more research is needed on the use of HRT among women who are transitioning through menopause, and the effects the hormones can have on women of different ages. They note that those involved in the WHI trial that found no long term benefits were on average 64 years old, which, the panel says, is “largely past the point of menopause onset.”
For now, major health organizations like the American Heart Association, the American Congress of Obstetricians and Gynecologists and the American Academy of Family Physicians also recommend against long-term HRT use in postmenopausal women to treat conditions other than menopausal symptoms.
“I agree with the USPSTF guidelines that hormone therapy should not be used for chronic disease prevention,” Dr. JoAnn E. Manson, chief of the division of preventive medicine at Brigham and Women’s Hospital in Boston told WebMD. “The pendulum has swung to the more appropriate place of hormone therapy reserved for the treatment of menopausal symptoms.”