October 2012 Task Force FINAL Recommendation | 1

Understanding Task Force Recommendations

Menopausal Hormone Therapy for the
Primary Prevention of Chronic Conditions
The U.S. Preventive Services Task Force (Task
Force) has issued nal recommendations on
Menopausal Hormone Therapy for the Primary
Prevention of Chronic Conditions.
These recommendations are for women who have
already gone through menopause and are thinking
about hormone therapy as a way to prevent chronic
conditions (illnesses that last a long time). The
recommendations dont apply to women who are
interested in hormone therapy to manage the
symptoms of menopause, such as hot ashes.
They also dont apply to women younger than age
50 who have had a hysterectomy (surgery to
remove the uterus) that resulted in menopause.
The Task Force reviewed recent research studies
on the use of hormone therapy to prevent chronic
conditions. These recommendations summarize
what the Task Force learned: The harms of hormone
therapy, when used to prevent chronic conditions,
outweigh the benets.
This fact sheet explains these recommendations
and what they might mean for you.
What is menopausal
hormone therapy?
The use of the female hormones estrogen and progestin to
treat symptoms of menopause and various medical conditions.
These medications can be given during or after menopause.
Hormone Therapy to Prevent Chronic Conditions
Many women take the hormones estrogen and progestin for a short period of time as they go through menopause to
help reduce troublesome symptoms, such as hot ashes and vaginal dryness. Women who have had a hysterectomy
and are going through menopause take estrogen by itself.
Today, many women live for 30 years or more after they go through menopause. As they get older, their risk of common chronic
conditions increases. These chronic conditions include heart disease, breast cancer, fractures, and dementia (problems with
thinking and memory). There is much interest and research in nding ways to prevent these chronic conditions.
Some research initially suggested that continuing hormone pills for the long term, after menopausal symptoms have ended, might
reduce the risk of some important common chronic conditions. However, more recent and larger studies, including a very large
study of many thousands of women, found that this is not true for most of these chronic conditions. In fact, using hormone therapy
to prevent chronic conditions can increase the risk of some of these conditions.
October 2012 Task Force FINAL Recommendation | 2
Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions
Potential Benets and Harms
The Task Force found that taking both estrogen and progestin after menopause reduces the risk of fractures. However,
the Task Force found that this type of hormone therapy also has important potential harms. It can increase the risk of breast
cancer, stroke, blood clots, and gallbladder disease. It also can increase the risk of dementia and urinary incontinence.
The Task Force found that taking estrogen alone after menopause (a choice that is only safe for women who have had a
hysterectomy) reduces the risk of fractures. It also appears to reduce the risk of breast cancer. However, the Task Force found that
this type of hormone therapy also has important potential harms. It can increase the risk of stroke, blood clots, gallbladder disease,
and urinary incontinence.
Combined Hormone Therapy with Estrogen and Progestin
For every 10,000 women who use combined
therapy each year, these events can occur as a result
Benets No change in risk Harms
46 avoid a fracture Heart disease 8 develop breast cancer
9 have a stroke
9 develop a serious blood clot
in their lungs
12 develop a serious blood clot
in their legs
20 develop gallbladder disease
22 develop dementia
872 develop urinary incontinence
Hormone Therapy with Estrogen Alone
For every 10,000 women who use estrogen therapy
each year, these events may occur as a result
Benets No change in risk Harms
56 avoid a fracture
8 avoid developing and 2 avoid
dying from breast cancer
Heart disease 11 have a stroke
7 develop a serious blood clot in
their legs
33 develop gallbladder disease
1,271 develop urinary incontinence
The Final Recommendations on Hormone Therapy to Prevent Chronic Conditions: What Do They Mean?
Here are the Task Forces nal recommendations on the use of hormone therapy to prevent chronic conditions. The recommendations
have letter grades. The grades are based on the quality and strength of the evidence about the potential benets and harms of
hormone use for this purpose. They are also based on the size of the potential benets and harms. Task Force evidence grades are
explained in the box at the end of this fact sheet.
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When the Task Force recommends against using medications for a particular purpose
(Grade D), it is because the medications have more potential harms than potential
benets. The Notes next to the recommendation help to explain key ideas.
Visit the Task Force Web site to read the full recommendation statement on the use of
hormone therapy to prevent chronic conditions. The statement explains the evidence the
Task Force reviewed and how it decided on the grades. An evidence report on this topic
provides more detail about the studies the Task Force considered.
Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions
The Task Force recommends against the use of combi ned
estrogen and progestin for the prevention of chronic
conditions in postmenopausal women. Grade D
1
The Task Force recommends against the use of estrogen
for the prevention of chronic conditions in postmenopausal women
who have had a hysterectomy. Grade D
2
Should You Use Hormone Therapy to Prevent Chronic Conditions?
Getting the best health care means making smart decisions
about what screening tests, counseling services, and preventive
medicines to get and when to get them. Many people dont get
the tests or counseling they need. Others get tests or counseling
they dont need or that may be harmful to them.
Task Force recommendations can help you learn about screening
tests, counseling services, and preventive medicines. These
services can keep you healthy and prevent disease. The Task Force
recommendations do not cover diagnosis (tests to nd out why you
are sick) or treatment of disease. Task Force recommendations also
apply to some groups of people, but not others. For example, this
recommendation does not apply to women who are interested in
hormone therapy to manage the symptoms of menopause. They
also dont apply to women younger than age 50 who have had a
hysterectomy that resulted in menopause.
Notes
use of combined...
Hormone therapy used in
women who have a uterus
prevention of chronic...
Use of hormone therapy to
reduce risk of heart disease,
fractures, dementia, breast
cancer; does not include
prevention of menopause
symptoms
postmenopausal women
Women who have already
been through menopause
use of estrogen
Hormone therapy used
in women who have had
a hysterectomy
hysterectomy
An operation to remove
the uterus (womb)
1
2
Your Decision
About Medication
Making a decision about using hormone therapy to prevent chronic conditions
Think about your own health and lifestyle. Consider your personal beliefs and preferences for
health care. Talk with a health care professional about whether the use of hormone therapy
to prevent chronic conditions is right for you. And consider scientic recommendations, like
this one from the Task Force.
October 2012 Task Force FINAL Recommendation | 4
Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions
What is the U.S. Preventive Services Task Force?
The Task Force is an independent group of national experts in prevention and evidence-
based medicine. The Task Force works to improve the health of all Americans by making
evidence-based recommendations about clinical preventive services such as screenings,
counseling services, or preventive medicines. The recommendations apply to people with
no signs or symptoms of the disease being discussed. Recommendations only address
services offered in the primary care setting or services referred by a primary care clinician.
To develop a recommendation statement, Task Force members consider the best available
science and research on a topic. For each topic, the Task Force posts draft documents for
public comment, including a draft recommendation statement. All comments are reviewed
and considered in developing the nal recommendation statement. To learn more, visit
the Task Force Web site.
USPSTF Recommendation Grades
Grade Denition
A Recommended.
B Recommended.
C Recommendation depends on the patients situation.
D Not recommended.
I statement There is not enough evidence to make a recommendation.
Click Here to Learn More
About Menopause and
Hormone Therapy
Postmenopausal
Hormone Therapy:
Information for the Public
(National Heart, Lung,
and Blood Institute)
Hormone
Replacement Therapy
(healthnder.gov)