USPSTF recommends against long-term HRT use after menopause

The Wall Street Journal reports that, in findings similar to what it arrived at in 2006, the US Preventive Services Task Force (USPSTF) issued an updated recommendation against the long-term use of hormone replacement therapy (HRT) for women who have undergone menopause. The updated clinical guidelines were published online in the Annals of Internal Medicine.

The Washington Post “The Checkup” blog reports, “Hormone replacement therapy (HRT) is not recommended for preventing chronic disease among post-menopausal women, as the health risks it poses outweigh its likely benefits.”

However, the statement “does not apply to the use of HRT for managing symptoms of menopause such as hot flashes and vaginal dryness. Nor does it apply to women younger than 50 who have had a hysterectomy.”

CQ reports, “Task force officials said hormone therapy is defined as the use of estrogen and progestin in postmenopausal women and estrogen alone in postmenopausal women who have had hysterectomies.”

HealthDay points out that the “independent panel of experts reviewed more than 50 articles published since 2002 about estrogen-progestin therapy and estrogen alone for prevention of heart disease, dementia, osteoporosis and other chronic conditions. It recommends against their use for all because of the increased risk of other conditions including stroke.”

WebMD explains, “The statement confirms a sea change in medical thinking on hormones. A decade ago, doctors called an early halt to a landmark study called the Women’s Health Initiative (WHI) after finding that women taking hormones had more heart attacks, strokes, and cancers than their peers who were taking placebo pills.”

According to Heartwire, “Outside experts polled by heartwire say this so-called ‘new’ review … hasn’t analyzed events by age. ‘Where I think this document is weak is that it doesn’t look in context about the way preventive care should be considered or used for postmenopausal women. They should have broken the data down by decade, age 50 to 59, etc,’ reproductive endocrinologist Dr Wulf Utian (Case Western Reserve University, Cleveland, OH) told heartwire.”

Utian also pointed out that the updated guidelines fail to take into account data from the recent KEEPS and Danish Osteoporosis Prevention Study.

One thought on “USPSTF recommends against long-term HRT use after menopause

  • Dr. Larimore, I agree with Dr. Utian in that the USPSTF recommendations do not account for the most recent data from KEEP and DOPS. Specifically DOPS, where patients were given 17 beta-estradiol (estrogen hormone produced in humans) and not premarin (estrogen hormone produced in horses). DOPS results imply that long-term use of HRT, when started soon after menopause, does not increase the risk of adverse cardiovascular events, specifically death, MI, or heart failure, as well have no increase risk of stroke.

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