WOMEN'S HEALTH
December 20, 2017

HRT, More Confusing News

A task force finds that hormone therapy carries more health risks than benefits, but what about short-term treatment?

If you’re a woman hoping that taking hormones will prevent chronic illnesses like stroke or heart disease, you may want to reconsider, according to the U.S. Preventive Services Task Force (USPSTF). They give hormone replacement therapy (HRT) a grade of “D,” for its potential in preventing chronic diseases in menopausal women. When it comes right down to it, they say, the risks don’t outweigh the benefits.

The group has made the same recommendations in years past, but periodically re-reviews the literature and reconsiders their stance. Looking over all the available evidence, the task force again concluded that combination HRT (estrogen and progesterone) does not prevent coronary heart disease, dementia, stroke, fractures and breast cancer in women without hysterectomy. Estrogen-only treatment is also not recommended for women who have undergone hysterectomy.

The U.S. Preventive Services Task Force gives hormone replacement therapy (HRT) a grade of “D,” for its potential in preventing chronic diseases in menopausal women.

Hormone therapy does have some benefits, however, namely in the prevention of bone fracture in women who have not undergone hysterectomy; in these women, it also seems to reduce the risk of colorectal cancer and diabetes, slightly.

But HRT seems to have more risks than benefits, including elevation of the risk of invasive breast cancer. It’s also been linked to increased risk for coronary heart disease, dementia, gallbladder disease, stroke, venous thromboembolism and urinary incontinence in women who have not undergone hysterectomy.

In women who have had a hysterectomy, HRT seems to reduce the risk of invasive breast cancer and diabetes, but raised the risks of the same illnesses mentioned earlier.

For both women with and without hysterectomy, therefore, the USPSTF doesn’t recommend starting HRT to ward off chronic disease.

But some doctors warn that the recurring recommendations may scare women away from the short-term benefits of using HRT. What it does seem to do well, and safely, is help women get through sometimes-debilitating symptoms of menopause. That is the point made in an accompanying editorial by Deborah Grady, a doctor and editor of JAMA Internal Medicine. She says that some women benefit greatly from HRT over the short term and urges doctors to distinguish between women who wouldn’t benefit from it and those who would.

“Estrogen (with or without progestins) is still, by far, the most effective therapy for menopausal vasomotor and vaginal symptoms, and there are not a lot of good alternatives,” she writes. “But many women have been so scared by the risks associated with preventive HT that they do not seek treatment of symptoms. I believe that this fear of HT is overblown.”

Whether you’re on HRT or just considering it, talk with your doctor about all the risks and benefits, depending on your particular situation. Though it may be ineffective or even harmful over the long-term, for short-term relief of menopause symptoms, HRT's benefits may still outweigh the risks.

The USPSTF guidelines are published in the Journal of the American Medical Association.

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