Guide to Clinical Preventive Services 2012 - Agency for Healthcare ...

HORMONE REPLACEMENT THERAPY FOR THE PREVENTION OF CHRONIC CONDITIONSIN POSTMENOPAUSAL WOMENCLINICAL SUMMARY OF U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONPopulation Postmenopausal women Postmenopausal women who have had a hysterectomyRecommendationDo not use combined estrogen and progestin for the preventionof chronic conditions.Grade: DDo not use unopposed estrogen for the prevention of chronicconditions.Grade: DThe probability that a menopausal woman will develop various chronic diseases during her lifetime is estimated to be:● ● 46% for coronary heart diseaseRisk Assessment● ● 20% for stroke● ● 15% for hip fracture● ● 10% for breast cancer● ● 2.6% for endometrial cancerPreventive Medication● ● Combined estrogen-progestin reduces the risk for fracturesand may possibly decrease colorectal cancer risk, but it has nobeneficial effect on coronary heart disease.● ● Combined estrogen-progestin increases the risk for stroke, breastcancer, dementia and lower global cognitive function, venousthromboembolism, and cholecystitis.● ● There is not enough evidence to determine the effects ofhormone therapy on the incidence of ovarian cancer, mortalityfrom breast cancer or coronary heart disease, or all-causemortality.● ● Estrogen alone decreases a woman’s risk for fractures, but it hasno beneficial effect on coronary heart disease.● ● Estrogen alone increases the risk for stroke, dementia and lowerglobal cognitive function, and thromboembolism.● ● The evidence is insufficient to determine the effects of unopposedestrogen on the incidence of breast cancer, ovarian cancer, orcolorectal cancer, as well as breast cancer mortality or all-causemortality.● ● Evidence about the effects of different dosages, types, anddelivery modes of hormone therapy remains insufficient.Balance of Benefits and HarmsOverall, the harmful effects of combined estrogen and progestin arelikely to exceed the benefits of chronic disease prevention for mostwomen.Overall, the harmful effects of unopposed estrogen are likely toexceed the chronic disease prevention benefits in most women.Clinical ConsiderationsThe balance of benefits and harms for a woman will be influenced by her personal preferences, her risks for specific chronic diseases, and thepresence of menopausal symptoms. A shared decisionmaking approach to preventing chronic diseases in perimenopausal and postmenopausalwomen involves consideration of individual risk factors and preferences in selecting effective interventions for reducing the risks for fracture,heart disease, and cancer.Other Relevant USPSTFRecommendationsOther USPSTF recommendations for prevention of chronic diseases (screening for osteoporosis, high blood pressure, lipid disorders, breastcancer, and colorectal cancer and counseling to prevent tobacco use) are available at http://www.uspreventiveservicestaskforce.org/.For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go tohttp://www.uspreventiveservicestaskforce.org/.37