Hormone Therapy Without Menopause Symptoms Discouraged

PHOTO: Postmenopausal women are continually discouraged from using hormone therapy for the prevention of chronic conditions like heart disease and bone loss, due to the risks involved.
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The U.S. government renewed its recommendation against prescribing hormone therapy to postmenopausal women for the prevention of chronic conditions like heart disease and bone loss, but didn't tackle whether women should take hormones to relieve their hot flashes and night sweats.

"The evidence shows that the harms of hormone therapy for the prevention of chronic conditions outweigh the benefits, which is what the evidence also showed in 2005," said Dr. Kirsten Bibbins-Domingo, a member of the Task Force. The task force only looks at preventative medicine and would not typically make a recommendation regarding whether women should use hormone therapy to relieve their menopause symptoms.

Since doctors haven't regularly prescribed hormones for chronic disease prevention since 2002 study findings showed the dangers of long-term hormone therapy, some doctors are worried patients will be confused by the Task Force recommendation.

"At the present time, the pendulum has already swung away from the use of hormone therapy for chronic disease prevention," Dr. JoAnn Manson, chief of preventative medicine at Brigham and Women's Hospital in Boston. "Recently, the consensus of the 15 top medical societies saying hormone therapy still has an important clinical role in management of night sweats and other menopause symptoms."

Like birth control and other drugs, hormone therapy comes with a set of risks, Manson said. As such, doctors should not prescribe them if they outweigh the benefits for a particular patient. If the patient has no symptoms, which would be the case if she is taking hormone therapy simply for "chronic disease prevention," the risks do not outweigh the benefits.

Two hormone therapy studies came out within a week of each other this month, generating excitement in the medical community because they showed positive results of using short-term hormone therapy for women who start it shortly after their last menstrual period: the Kronos Early Estrogen Prevention Study nicknamed KEEPS, and a Danish study.

However, the Task Force did not consider either of them because they were not available when it was making its decision, Bibbons-Domingo said.

"In the context of the larger body of evidence the Task Force considered when making this recommendation, it is unlikely that this study would have altered the balance of harms versus benefits and led the Task Force to a different recommendation," Bibbons-Domingo said.

According to the review published in the Annals of Internal Medicine, researchers looked at studies from 2002 forward and chose nine on which to base the Task Force recommendation. They found that estrogen and progestin reduced bone fractures but increased invasive breast cancer stroke and other ailments.

The first study to raise the alarm on hormone therapy was the Women's Health Initiative, or WHI, which stopped prescribing hormone pills to its 160,000 participants between the ages of 50 and 79 in 2002, the year it found that the hormones made women more likely to develop aggressive breast cancer. The participants been taking the pills for 10 years because doctors believed the pills would prevent chronic diseases. Follow-ups continued through 2010.

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