May 16, 2022
National Center for Health Research’s Comments on U.S. Preventive Services Task Force’s Draft Recommendation Hormone Therapy in Postmenopausal Women for the Primary Prevention of Chronic Conditions
We are writing to express our views on the U.S. Preventive Services Task Force’s (USPSTF) draft recommendation on hormone therapy in postmenopausal women for the primary prevention of chronic conditions.
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
The currently available evidence on hormone therapy is very clear: Whether combination therapies of estrogen and progestin or treatments with estrogen alone, the risks by far outweigh the limited benefits for postmenopausal women. We thus strongly support USPSTF’s “D” grade recommendation against the use of combined estrogen and progestin for the primary prevention of chronic conditions such as cardiovascular disease, types of cancer, and osteoporotic fractures in postmenopausal persons, as well as the “D” grade recommendation against the use of estrogen alone in postmenopausal persons who have had a hysterectomy.
For example, while the combination therapy of estrogen and progestin is associated with modest reductions in the risk of fractures, diabetes, or colon cancer, these limited benefits are outweighed by an increased risk for invasive breast cancer, stroke, thromboembolic events (such as venous thrombosis, deep vein thrombosis, and pulmonary embolism), dementia, gallbladder disease, and urinary incontinence. Current data indicate that these hormonal therapies do not protect against coronary heart disease.
USPSTF states that estrogen only therapy has been associated with a reduction in fracture risk, diabetes, and developing or dying of invasive breast cancer. At the same time, these treatments are associated with an increase in the risk of stroke, deep vein thrombosis, pulmonary embolism, gallbladder disease, and urinary incontinence. Estrogen only therapy has not been shown to help prevent coronary heart disease.
We agree with USPSTF that more evidence is needed on the impact that age and timing of hormone therapy initiation can have on health outcomes and how the benefits and harms of hormone therapy differ across different population groups. More data on the benefits and harms of different doses, modes of delivery, and length of treatments are also needed.
The National Center for Health Research can be reached at info@center4research.org or at (202) 223-4000.