Women advised to steer clear of hormone replacement therapy

Washington: Women who are past menopause and healthy should not use hormone replacement therapy in hopes of warding off dementia, bone fractures or heart disease, says a new analysis that weighs the risks and benefits of screening and other therapies aimed at preventing illness.

But the recommendation by the US Preventive Services Task Force does not necessarily apply to women who use hormone replacement therapy to reduce menopausal symptoms such as hot flashes, night sweats and vaginal dryness, the LA Times reported.

Published in the Annals of Internal Medicine, the recommendation is largely based on revised analyses of the landmark Women’s Health Initiative, a 15-year study involving more than 160,000 women.

The task force found limited evidence that hormones protect against bone fractures, and no evidence that they reduce the most probable threat — heart disease. It also found that for most menopausal women using hormone therapy, the risk of developing dementia later in life actually rose a bit.

Against such sparse benefits, the panel weighed relatively new evidence of the risks, including a significantly higher rate of life-threatening blood clots in the legs and lungs, a greater probability of gallbladder disease and increased risk of urinary incontinence that persisted in studies for at least three years.

Dr. Kirsten Bibbins-Domingo, chairwoman of the panel, said members took pains to put the possible benefits of hormone replacement therapy in context. One form of the therapy — estrogen alone — did appear to slightly reduce the incidence of breast cancer. Invasive breast cancer looms large as a concern to many women but affects just 11percent of them after menopause.

That possible protective effect became less consequential when weighed against hormone therapy’s effects on far more likely risks to women’s health, said Bibbins-Domingo, professor of medicine and of epidemiology and biostatistics at UC San Francisco: It fails to reduce the risk of heart disease, which will affect 30 percent of women who live past menopause.

It slightly increased the likelihood of dementia, which will affect 22 percent of all postmenopausal women. It was linked to a higher likelihood of stroke, affecting 21 percent of these women. And although it slightly reduced the rate of hip fractures, which affect 15 percent of women past menopause, other medications can do that more effectively.

The task force said its decision to recommend against hormone therapy for prevention of chronic diseases was based on “at least fair” evidence that the harm outweighed the benefits, or that its use was ineffective.


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