New study sounds warning on hormone replacement therapy

Women who are past menopause and healthy should not use hormone replacement therapy in hopes of warding off dementia, bone fractures or heart disease, says a new analysis by the government task force that weighs the risks and benefits of screening and other therapies aimed at preventing illness.

The recommendation by the U.S. Preventive Services Task Force does not necessarily apply to women who use hormone replacement therapy to reduce menopausal symptoms such as hot flashes, night sweats and vaginal dryness. The balance of harm and benefits for that use is expected to be addressed soon in a report by the federal Agency for Healthcare Research and Quality.

The latest recommendation, published Monday in the Annals of Internal Medicine, comes from an organization accustomed to controversy. In recent months, the task force has recommended against routine breast cancer screenings for most women younger than 50. It has also urged abandonment of the prostate-specific antigen, or PSA, test that has become a standard part of older men's yearly physicals.

Its latest recommendation could be a bit less controversial but is likely to have detractors among physicians who believe that the dangers of hormone replacement therapy for menopausal women have been overblown.

The recommendation is largely based on revised analyses of the landmark Women's Health Initiative, a 15-year study involving more than 160,000 women. It comes a decade after the study first linked hormone replacement therapy with higher rates of invasive breast cancer. Those initial findings prompted droves of women to abandon or avoid hormone therapy.

But a decade of subsequent research tempered much of the fear, and preliminary but conflicting studies had suggested that some postmenopausal women taking hormones might benefit from lower rates of bone fractures, dementia and heart disease.

The task force found limited evidence that hormones protect against bone fractures, and no evidence that they reduce the most probable threat heart disease. It also found that for most menopausal women using hormone therapy, the risk of developing dementia later in life actually rose a bit.

Against such sparse benefits, the panel weighed relatively new evidence of the risks, including a significantly higher rate of life-threatening blood clots in the legs and lungs, a greater probability of gallbladder disease and increased risk of urinary incontinence that persisted in studies for at least three years.

Dr. Kirsten Bibbins-Domingo, chairwoman of the panel, said members took pains to put the possible benefits of hormone replacement therapy in context. One form of the therapy estrogen alone did appear to slightly reduce the incidence of breast cancer. Invasive breast cancer looms large as a concern to many women but affects just 11% of them after menopause.

That possible protective effect became less consequential when weighed against hormone therapy's effects on far more likely risks to women's health, said Bibbins-Domingo, professor of medicine and of epidemiology and biostatistics at UC San Francisco: It fails to reduce the risk of heart disease, which will affect 30% of women who live past menopause.

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New study sounds warning on hormone replacement therapy