Hormone Therapy After Menopause

U.S. Preventive Services Task Force: Postmenopausal hormone replacement therapy for primary prevention of chronic conditions: recommendations and rationale. Ann Int Med 2002; 137(10):834-839.

Most guidelines on postmenopausal hormone replacement therapy (HRT) have changed in light of the findings from recently reported trials. The U.S. Preventive Services Task Force (USPSTF) now recommends against the routine use of estrogen and progestin for the prevention of chronic conditions in postmenopausal women.

Evidence was deemed insufficient to recommend for or against the use of unopposed estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. Complete information is available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov) and through the National Guideline Clearinghouse (http://www.guideline.gov).

The use of HRT to relieve symptoms of menopause such as hot flashes, urogenital symptoms, and mood disturbances was not evaluated. HRT prevents osteoporosis and fractures but increases risks for breast cancer, venous thromboembolism, coronary heart disease, stroke, and cholecystitis. The USPSTF concluded that the harmful effects of estrogen and progestin are likely to exceed chronic disease prevention benefits in most women. However, the absolute increase in risk from HRT is modest, and some women may decide that the benefits of taking HRT outweigh the potential harms.