Chemoprevention

Hormone Replacement Therapy

U.S. Preventive Services Task Force
Update, 2002 Release

Summary of Recommendations

• The U.S. Preventive Services Task Force (USPSTF) recommends against the
  routine use of estrogen and progestin for the prevention of chronic conditions
  in postmenopausal women. D
  recommendation.
  Rationale: The USPSTF found fair to good
  evidence that the combination of estrogen and progestin has both benefits and
  harms. Benefits include increased bone mineral density (good evidence),
  reduced risk for fracture (fair to good evidence), and reduced risk for
  colorectal cancer (fair evidence). Harms include increased risk for breast
  cancer (good evidence), venous thromboembolism (good evidence), coronary heart
  disease (CHD) (fair to good evidence), stroke (fair evidence), and
  cholecystitis (fair evidence). Evidence was insufficient to assess the effects
  of HRT on other important outcomes, such as dementia and cognitive function,
  ovarian cancer, mortality from breast cancer or cardiovascular disease, or
  all-cause mortality.

  The USPSTF concluded that the harmful effects of estrogen and progestin are
  likely to exceed the chronic disease prevention benefits in most women. The
  USPSTF did not evaluate the use of HRT to treat symptoms of menopause, such as
  vasomotor symptoms (hot flashes) or urogenital symptoms. The balance of
  benefits and harms for an individual woman will be influenced by her personal
  preferences, individual risks for specific chronic diseases, and the presence
  of menopausal symptoms.

• The USPSTF concludes that the evidence is 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. I
  recommendation.
  Rationale: The USPSTF found fair-to-good
  evidence that the use of unopposed estrogen has both benefits and harms.
  Although most current data come from observational studies, likely benefits
  include increased bone mineral density, reduced fracture risk, and reduced
  risk for colorectal cancer. Likely harms include increased risk for venous
  thromboembolism, cholecystitis, and stroke; in women who have not had a
  hysterectomy, unopposed estrogen increases the risk for endometrial cancer.
  Evidence is insufficient to determine the effects of unopposed estrogen on the
  risk for breast and ovarian cancer, CHD, dementia and cognitive function, or
  mortality. As a result, the USPSTF could not determine whether the benefits of
  unopposed estrogen outweigh the harms for women who have had a hysterectomy.

  Better data on benefits and harms are expected from ongoing randomized
  trials, including the Women’s Health Initiative (WHI) study of unopposed
  estrogen in women who have had a hysterectomy.³

Guide to
Clinical Preventive Services, 3rd Edition: Periodic Updates (available
early 2003)
Hormone Replacement Therapy, 2002
Recommendations and
Rationale (PDF
file, 87 KB)
Summary of the
Evidence (PDF file, 138
KB)
Systematic Evidence Reviews
   HRT and Breast Cancer
(File Download,
203 KB)
   HRT and Cardiovascular Disease (File Download,
536 KB)
   HRT and
Cognition (File
Download, 144 KB)
   HRT and Osteoporosis (File Download, 103
KB)
   HRT and
Venous Thromboembolism (File Download, 132
KB)

What’s New (PDF file, 73
KB)
Press
Release

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