Estrogen should not be taken by postmenopausal women who’ve had a
hysterectomy
A recommendation was
issued by the US Preventive Services Task Force against the routine use of
estrogen to prevent chronic conditions such as heart disease, stroke and
osteoporosis in postmenopausal women who’ve undergone a hysterectomy. This
recommendation, which appeared in a recent issue of the Annals of
Internal Medicine, is based on recent evidence from the National
Institutes of Health’s Women’s Health Initiative (WHI) clinical trial and
other studies.
The Task Force, which
is supported by the Agency for Healthcare Research and Quality (AHRQ) of
Rockville, Md., is an independent panel of private sector experts in
prevention and primary care. It conducts rigorous, impartial assessments of
the scientific evidence for a broad range of preventive services.
After reviewing
findings from the WHI, the Task Force noted that, although estrogen can have
positive effects such as reducing the risk for fractures, hormone therapy
should not be used routinely because it appears to increase women’s risk for
potentially life-threatening clots that block blood vessels (venous
thromboembolism), stroke, dementia and mild cognitive impairment. The Task
Force noted that while the use of estrogen reduces the risk for fracture,
for most women the harmful effects of estrogen therapy outweigh any benefits
for fracture and other chronic conditions.
Additionally, the Task
Force reaffirmed an earlier recommendation against the routine use of
combined estrogen and progestin for preventing chronic conditions in
postmenopausal women. Although the combination therapy may reduce risk for
fractures in women diagnosed with osteoporosis and for colorectal cancer, it
has no beneficial effect on heart disease and may even put women at greater
risk for the condition.
Other potential harms
of combined estrogen and progestin include increased risk for breast cancer,
venous thromboembolism, inflammation of the gallbladder, dementia and mild
cognitive impairment. The Task Force concluded that the harmful effects of
combined estrogen and progestin are likely to exceed the chronic disease
prevention benefits for most women.
Menopause occurs in
most 41-59 year-old women in the US, although the body’s production of
estrogen and progestin may begin to decrease years before. The average woman
going through menopause has a 46% likelihood of developing heart disease
over her lifetime, a 20% likelihood of stroke, a 15% likelihood of bone
fracture, and a 10% chance of developing breast cancer. The Task Force did
not examine the effects of estrogen only or combined estrogen and progestin
for the treatment of menopausal symptoms, only for the prevention of chronic
disease.
“The available studies
have shown that hormone replacement therapy should not be used to prevent
heart disease, cancer, and bone fractures,” said Task Force Chair Ned
Calonge, MD, who is also chief medical officer and state epidemiologist for
the Colorado Department of Public Health and Environment.
AHRQ Director Carolyn
M. Clancy, MD, added, that the “evidence can…help women become better
informed patients and decide with their clinicians what alternatives are
available to prevent these chronic diseases.”
SOURCE:
Ann Intern Med
May 17, 2005;142:855-60.
