Routine hormone therapy not recommended for most postmenopausal women

Recommendations issued by the US Preventive Services Task Force of the Agency for Healthcare Research and Quality, Rockville, Maryland conclude that there are “benefits and harms” from the use of estrogen, with or without progestin, for the prevention of chronic conditions in postmenopausal women.

The apparent benefits of combination therapy include a reduced risk of fracture and possibly colorectal cancer, Task Force Chairman Dr. Ned Calonge of the Colorado Department of Health and Environment, Denver, and colleagues report in the May 17th issue of the Annals of Internal Medicine.However, combined estrogen and progestin has no beneficial effect on coronary heart disease (CHD) and may even increase the risk of CHD. Other drawbacks include an increased risk of breast cancer, venous thromboembolism and possibly stroke. Other potentially negative effects are an increased risk of cholecystitis, dementia and reduced global cognitive function.Unopposed estrogen also appears to reduce the risk of fracture, but has no beneficial effect on CHD. It also may increase the risk of venous thromboembolism, stroke, dementia and it may lower global cognitive function.Dr. Calonge’s group notes there is currently insufficient evidence to assess the effects of estrogen and progestin or estrogen alone on a number of outcomes including breast cancer mortality and all-cause mortality.Nevertheless, they do not recommend routine use of estrogen and progestin for the prevention of chronic conditions in postmenopausal women. Overall, the harmful effects of combination therapy or unopposed estrogen, they conclude, “are likely to exceed the chronic disease prevention benefits in most women.”(Source: Ann Intern Med 2005;142:855-860: Reuters Health: Oncolink: June 2005.)