By DENISE GRADY, The New York Times
October 17, 2002
A medical panel that helps set government policy has joined the growing ranks of experts registering doubts about the value of hormone replacement therapy in preventing many of the chronic diseases associated with aging.
Stating that the risks of the hormones outweigh their benefits, the group recommended “against the routine use of estrogen and progestin for the prevention of chronic conditions in postmenopausal women.”
The panel, the United States Preventive Services Task Force, issued a set of guidelines for doctors on Tuesday, based on its review of hundreds of studies. The task force is an independent, 14-member group of experts that advises the federal government, and its recommendations are generally adopted by Medicare, health plans and insurers.
Hormone replacement has been used for decades and was widely believed to prevent heart disease and to prolong youth and health. But recent studies have contradicted those theories.
Even though hormones can prevent osteoporosis, broken bones and colorectal cancer, the panel said it did not recommend them for those purposes because the hormones also increase the risk of breast cancer, heart attacks, strokes, gallbladder disease and blood clots. The panel advised women concerned about bone loss to consult their doctors about nonhormonal ways to prevent it.
Other medical groups, including the American Heart Association, have said that hormone replacement should not be used to prevent heart disease. The American College of Obstetricians and Gynecologists and the North American Menopause Society agree and also urge caution in using hormones solely to prevent osteoporosis.
The task force did not advise for or against hormone therapy to treat menopausal symptoms like hot flashes, night sweats and vaginal irritation, conditions for which doctors agree hormones are the most effective treatment. Instead, the group said women should consult their doctors about whether to use hormones. Many doctors advise women who are suffering from those symptoms to take the lowest dose of hormones for the shortest time possible.
Dr. Janet D. Allan, vice chairwoman of the task force and dean of the school of nursing at the University of Maryland in Baltimore, said the group did not make recommendations about treating symptoms because its purpose was to evaluate preventive medicine for healthy people, not treatments for people with symptoms.
The task force did not make any recommendations about the use of estrogen alone, without progestin, a treatment prescribed for women who have had hysterectomies. No recommendations were possible, the group said, because there is not enough evidence about the treatment. But studies are under way.
Dr. Allan said one federally financed study, the Women’s Health Initiative, was particularly important to the task force because it was a large and rigorously conducted clinical trial. The portion of the study that tested estrogen and progestin, the ingredients of the widely used drug Prempro, was abruptly halted in July because the hormones caused a small but significant increase in the risk of invasive breast cancer. The study also found increases in heart attack, stroke and blood clots, but decreases in broken hips and colorectal cancer.
“There are a lot of questions,” Dr. Allan said. “We don’t know a lot about other combinations of hormones. They may have more or less harms. We’ll continue to look to try to get a clearer picture. There may be groups of women for whom there is less harm, and groups for whom there is more. We don’t know.”
The task force guidelines have been posted on the Web site of the Annals of Internal Medicine, www.acponline.org/journals /annals/hrt.htm, and will be published in the Nov. 19 issue of the journal.