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The U.S. Preventive Services Task Force recently issued a new recommendation against the routine use of estrogen to prevent chronic conditions such as heart disease, stroke, and osteoporosis in postmenopausal women who have undergone a hysterectomy. This recommendation is based on recent evidence from the National Institutes of Health's Women's Health Initiative clinical trial and other studies.
In 2002, the Task Force found insufficient evidence to recommend for or against the routine use of estrogen alone to prevent chronic conditions in women who have completed menopause and had a hysterectomy. Now, after reviewing new findings from the Women's Health Initiative, the Task Force noted that although estrogen can have positive effects such as reducing the risk for fractures, hormone therapy should not be used routinely because it appears to increase women's risk for potentially life-threatening clots that block blood vessels (venous thromboembolism), as well as stroke, dementia, and mild cognitive impairment.
The Task Force noted that although the use of estrogen reduces the risk for fracture, drugs such as bisphosphonates and calcitonin are available and effective in helping prevent fractures in women diagnosed with osteoporosis. The Task Force concluded that for most women, the harmful effects of estrogen therapy outweigh any benefits for preventing fracture and other chronic conditions.
In addition, the Task Force reaffirmed its earlier recommendation against the routine use of combined estrogen and progestin for preventing chronic conditions in postmenopausal women. Although the combination therapy may reduce risk for fractures in women diagnosed with osteoporosis and for colorectal cancer, it has no beneficial effect on heart disease and may even put women at greater risk for the condition. Other potential harms of combined estrogen and progestin include increased risk for breast cancer, venous thromboembolism, inflammation of the gallbladder, dementia, and mild cognitive impairment. The Task Force concluded that the harmful effects of combined estrogen and progestin are likely to exceed the chronic disease prevention benefits for most women.
The Task Force did not examine the effects of estrogen only or combined estrogen and progestin for the treatment of menopausal symptoms. Menopause occurs in most U.S. women between 41 and 59 years of age, although the body's production of estrogen and progestin may begin to decrease years before. The average woman going through menopause has a 46 percent likelihood of developing heart disease over her lifetime, a 20 percent likelihood of stroke, a 15 percent likelihood of bone fracture, and a 10 percent chance of developing breast cancer.
The Task Force, which is supported by AHRQ, is the leading independent panel of private-sector experts in prevention and primary care. Its recommendations are considered the gold standard for clinical preventive services. The Task Force conducts rigorous, impartial assessments of the scientific evidence for a broad range of preventive services.
The Task Force grades the strength of its evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against), or "I" (insufficient evidence to recommend for or against). The Task Force recommends against the routine use of unopposed estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy (a "D" recommendation). The Task Force recommends against the routine use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women (a "D" recommendation).
Select for more information on this recommendation and to access previous Task Force recommendations, including screening for osteoporosis, high blood pressure, breast cancer, colorectal cancer, and lipid disorders, as well as summaries of the evidence and related materials. Print materials are available from the AHRQ Publications Clearinghouse.
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