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Task Force against hormone therapy for disease prevention

A panel of doctors who advise the government on medical policy say women should not take hormones to reduce their risk for chronic disease.

The U.S. Preventive Services Task Force final recommendation against hormonal therapy doesn't apply to women who use it to treat menopausal symptoms, such as hot flashes. But outside of this use, women who opt for long-term hormonal therapy may face more risks than benefits, the task force said.

"In the past, it was thought that taking hormones after menopause ended might reduce a woman's risk of developing certain chronic diseases, such as heart disease or dementia," Task Force member Dr. Kirstin Bibbins-Domingo, an associate professor of medicine and epidemiology at UCSF Medical Center in San Francisco, said in an emailed statement. "However, its use in this way does not help prevent these conditions and may even increase a woman's chance of developing them."

The recommendations were published Oct. 23 in the Annals of Internal Medicine.

Hormone therapy or hormone replacement therapy (HRT) is used to supplement the body with estrogen or estrogen and progesterone during and after menopause, according to WebMD. Lowered levels of estrogen may cause menopausal symptoms and raise risk for osteoporosis.

U.S. women who reach menopause are expected to live another 30 years, according to the task force. During that time they face a 30 percent risk of developing heart disease, 22 percent risk for dementia, 15 percent risk for hip fracture and an 11 percent risk for developing breast cancer.

Previously doctors routinely recommended hormone therapy to stave off diseases, based on research suggesting protective benefits. In 2002 however, the Women's Health Initiative -- a large U.S. study dating back to the 1990s -- found estrogen-progestin therapy raised the risk for heart attacks and breast cancer, causing the researchers to stop that part of the study. In 2004, the researchers halted the estrogen arm of the study after finding stroke and blood clot risks in women.

After reviewing 51 studies on hormone therapy that have been published since 2002, the task force found the risks associated with hormone therapies outweigh any reported benefits of chronic disease prevention.

While the task force found evidence estrogen and progestin may reduce a woman's risk for bone fractures, it found an elevated risk for stroke, blood clots, pulmonary embolism, gallbladder disease and urinary incontinence.

Other mixed findings showed taking estrogen alone decreased breast cancer risk for women, however estrogen plus progestin made women more likely to develop dementia and breast cancer.

The totality of the evidence led the task force to give its "Grade D" recommendation, which means it advised against the treatment for chronic disease prevention.

"Everyone is interested in preventing chronic diseases," said Dr. Bibbins-Domingo. "The task force recommends a number of important preventive measures women can take to avoid chronic diseases, including quitting smoking and identifying and treating high blood pressure and high cholesterol."

Bibbins-Domingo however notes to WebMD, "Nothing about our guidelines is meant to replace a woman's conversation with her doctor."

One doctor not involved in the report, Dr. Michael Nimaroff, vice chair of obstetrics and gynecology at North Shore University Hospital of the LIJ Health System in Great Neck, told HealthDay that the recommendations won't change how he practices.

"We currently aren't using it for chronic disease," he said.

The Food and Drug Administration only indicates hormone therapy for postmenopausal women with menopausal symptoms and for the prevention of osteoporosis.

"It is very important that patients understand what this report does not say: It does not recommend against the use of hormone therapy for the relief of menopausal symptoms," the American Society for Reproductive Medicine said in a statement emailed to

The U.S. Preventive Services Task Force has more on its hormonal therapy recommendations.

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