USPSTF recommends against hormone therapy to prevent postmenopausal chronic disease

The United States Preventive Services Task Force has released two final recommendations regarding the use of hormone therapy for the primary prevention of postmenopausal chronic disease.

Recommendations are against the use of menopausal hormone therapy (MHT) with estrogen and progestin in postmenopausal people and against the use of estrogen-only MHT in postmenopausal people who have had a hysterectomy. I advocate.

Both are D-grade recommendations, consistent with previous USPSTF recommendations for treatment. Created in 2017.

“For those who have already gone through menopause, the use of hormone therapy is not an effective way to prevent chronic disease because the potential harms outweigh the potential benefits,” said the USPSTF chair. Carol Mangione, MD, MSPH, said in a press release.

James Stevermer, M.D., MSPH, In a press release, task force members said the recommendations were intended only for those considering hormone therapy to prevent postmenopausal chronic disease.

“Those who wish to manage menopausal symptoms with hormone therapy are advised to consult with a medical professional.

Additionally, according to the USPSTF statement, these recommendations do not apply to those who have gone through premature menopause or surgical menopause.

In the evidence report Gerald Gartrainer, MD, MPH, Senior health research analysts and colleagues at RTI International, based in North Carolina, conducted analyzes of 20 trials (n = 39,145) (17 of which were conducted in the US) and 3 cohort studies (n = 1,155,410) Did.

Compared to placebo, the researchers found that participants who used estrogen-only MHT had a lower risk of diabetes per 10,000 over 7.1 years (1,050 vs. 903; 134 fewer; 95% CI, 18- 237), 7.2 years fracture (1,413 vs. 1,024 cases; 388 fewer cases; 95% CI, 277–489).

However, compared to participants who received placebo, the risk per 10,000 participants who received estrogen was significantly increased only when:

• Gallbladder disease over 7.1 years (1,113 vs 737 cases; ≥377 cases; 95% CI, 234-540);
• Urinary incontinence ≥1 year (2,331 vs. 1,446 cases; >885 cases; 95% CI, 659-1,135);
• 7.2 years of stroke (318 vs. 239 cases; ≥79 cases; 95% CI, 15-159); and
• Venous thromboembolism over 7.2 years (258 vs 181 cases; ≥77 cases; 95% CI, 19-153).

Compared to placebo cases, participants taking combined estrogen and progestin MHT had a lower risk of diabetes per 10,000 over 5.6 years (403 vs. 482 cases; fewer than 78 cases; 95% CI, 15 -133), reducing the risk of colorectal cancer over 5.6 years. (59 vs. 93 cases; 34 fewer cases; 95% CI, 9-51), and fractures over 5 years (864 vs. 1,094 cases; 230 fewer cases; 95% CI, 66-372). For:

• 5.6 years or older with invasive breast cancer (242 vs. 191 cases; ≥51 cases; 95% CI, 6-106);
• Gallbladder disease over 5.6 years (723 vs 463 cases; >260 cases; 95% CI, 169–364);
• 5. Stroke ≥6 years (187 vs 135 cases; ≥52 cases; 95% CI, 12-104);
• Venous thromboembolism over 5.6 years (246 vs 126 cases; >120 cases; 95% CI, 68-185);
• likelihood of dementia over 4 years (179 vs 91 cases; >88 cases; 95% CI, 15-212);
• Urinary incontinence ≥1 year (1,707 vs. 1,145 cases; >562 cases; 95% CI, 412–726).

In a related editorial, Alison J.H.you, MD, MAS, Professor of Medicine, University of California, San Francisco, and Deborah Grady, MD, MPH, A UCSF professor of medicine and epidemiology and biostatistics cites five MHT statements from the past two decades to question the need for continued recommendations on hormone therapy to prevent postmenopausal chronic disease. did.

“Most of these persistent questions center around the potential impact of MHT timing, i.e., the potential effects of MHT in the first few years after menopause, even with continued use beyond five or ten years after menopause. Huang and Grady found that the new additions to the evidence report provided little evidence to solidify the hypothesis. pointed out.

“For a limited period of time, instead of investing additional resources to analyze a subset of menopausal patients who may benefit from some preventive benefit from MHT, more thoughtfulness for individual decision-making regarding MHT for menopausal symptoms may be warranted.” Research needs to focus on developing and implementing in-depth guidance: more rigorous and extended follow-up of other drugs used to treat menopausal symptoms,” they concluded. .

References: