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Use HT for symptoms, not disease prevention.

combined estrogen and progestin should not be used to prevent osteoporosis or other chronic conditions in postmenopausal women, according to recommendations issued by t the U.S. Preventive Services Task Force.

Hormone therapy has Food and Drug Administration approval for use in the I prevention of osteoporosis in post-menopausal women.

The task force, an independent body of volunteer experts that advises the U.S. Health and Human Services department, issued the recommendations as an update of its 2005 statement on hormone therapy for prevention of disease in postmenopausal women.

Using the most recent scientific evidence available, including long-term follow-up data from the Women's Health Initiative (WHI) studies of hormone therapy use in postmenopausal women, the task force reached the same conclusions as it had in 2005, advising against combined estrogen and progestin for prevention of chronic conditions, and also against the use of estrogen alone for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.

The task force emphasized that hormone therapy was still indicated for the management of menopausal symptoms, such as hot flashes or vaginal dryness. It additionally made clear that its recommendation against hormone therapy for disease prevention does not apply to women under age 50 who have undergone surgical menopause.

Prior to the WHI studies, a series of government-funded trials that began in the 1990s with follow-up ending in 2010, hormones had been widely used for the prevention of bone disease in postmenopausal women. Both estrogen and combined estrogen and progestin are known to reduce fracture risk.

However, both forms of hormone therapy were shown during the WHI studies to increase the risk of serious adverse events, to the point where the trials were stopped early. In one randomized, placebo-controlled trial, estrogen alone was associated with a higher risk of stroke, deep vein thrombosis, and gallbladder disease, while combined therapy was associated with an increased risk of stroke, invasive breast cancer, dementia, gallbladder disease, deep vein thrombosis, and pulmonary embolism.

Reproductive endocrinologist Jan L. Shifren of the department of obstetrics and gynecology and reproductive biology at Harvard Medical School and director of the menopause program at Massachusetts General Hospital, both in Boston, said in an interview that the task force's updated position largely reflected the current consensus, "which is that HT should not be used to prevent the diseases of aging."

The task force was "careful to point out that they are not saying HT should not be used for the treatment of vasomotor symptoms or vaginal atrophy. It's not that normones aren't indicated; they're just lot indicated for prevention. They remain appropriate treatment for otherwise healthy, symptomatic women at the menopause transition," said Dr. Shifren, who is not on the task force.

FDA-approved indications for hormone therapy in postmenopausal women include treatment of menopausal symptoms and prevention of osteoporosis.

A black box warning indicates that estrogen with or without progestin should be prescribed at the lowest effective dose and for the shortest time possible. The task force's findings were based on the dosages and formulations used in the WHI trials: oral conjugated equine estrogen (0.625 mg/day plus medroxyprogesterone acetate, 2.5 mg/day) or estrogen 0.625 mg/day alone.

Task force members declared no relevant financial conflicts of interest.

The task force reached the same conclusions as it had in 2005, advising against combined estrogen and progestin for prevention of chronic conditions.
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Title Annotation:ENDOCRINOLOGY
Author:Smith, Jennie
Publication:Internal Medicine News
Date:Nov 15, 2012
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