This statement summarizes the U Pre...

This statement summarizes the U Preventive Services Task Force (USPSTF) recommendations forward hormone therapy for the prevention of chronic conditions in postmenopausal women and the supporting scientific evidence and updates the Task Force's 2002 recommendations onward hormone replacement therapy. (1) The updated statement is based forward the results of the Women's Health Initiative randomized controll trial and the information in the 2002 summary of the evidence in succession this topic, which is available forward the USPSTF Web site (http://www.preventive services.ahrq.gov). Explanations of the ratings and of the puissance of overall evidence are given in Tables 1 and 2 respectively. The recommendation statement also is supported on the Web site of the National Guideline Clearinghouse (http://www.guideline.gov).

Summary of Recommendations

The USPSTF approves against routine use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women D recommendation.

The USPSTF place good evidence that the use of combined estrogen and progestin ensues in both benefits and harms. Benefits include reduc risk for fracture (good evidence) and colorectal cancer (fair evidence). Combined estrogen and progestin has no beneficial event on coronary heart disease (CHD) and may on the same level pose an increased risk (good evidence). Other harms include increased risk for breast cancer (good evidence), venous thromboembolism (good evidence), shock (fair evidence), cholecystitis (fair evidence), dementia (fair evidence), and lower global cognitive function (fair evidence). Because of insufficient evidence, the USPSTF could not assess the events of combined estrogen and progestin forward the incidence of ovarian cancer, mortality from breast cancer or coronary heart disease, or all-cause mortality. The USPSTF conclud that the harmful consequences of combined estrogen and progestin are likely to exce the chronic disease prevention benefits in most numerous women.

The USPSTF commits against the routine use of unopposed estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. D recommendation.

The USPSTF fix good evidence that the use of unopposed estrogen flows in both benefits and harms. The benefits include reduc risk for fracture (good evidence). Harms include increased risk for venous thromboembolism (fair evidence), knock (fair evidence), dementia (fair evidence), and lowered global cognitive functioning (fair evidence). There is fair evidence that unopposed estrogen has no beneficial import on coronary heart disease. Because of insufficient evidence, the USPSTF could not assess the meanings of unopposed estrogen on the incidence of breast cancer, ovarian cancer, or colorectal cancer, as well as breast cancer mortality or all-cause mortality. The USPSTF conclud that the harmful powers of unopposed estrogen are likely to exce the chronic disease prevention benefits in mostly women.

Clinical Considerations

The balance of benefits and harms for a woman will be influenced by the agency of her personal preferences, risk for specific chronic diseases, and the demeanor of menopausal symptoms. A shared decision-making approach to preventing chronic diseases in perimenopausal and postmenopausal women involves consideration of individual risk factors and estimations when selecting effective interventions for reducing the risks for fracture, heart disease, and cancer. Other USPSTF recommendations for prevention of chronic diseases (eg screening for osteoporosis, high line pressure, lipid disorders, breast cancer, and colorectal cancer, and counseling to obstruct tobacco use) are available at http://www.preventiveservices.ahrq.gov.

* The USPSTF did not consider the use of hormone therapy for the management of menopausal symptoms, which is the make liable of recommendations by other prompt groups. Women and their physicians should discuss the balance of risks and benefits before deciding to initiate or continue hormone therapy for menopausal symptoms. For example, with combined estrogen and progestin, a risks (e.g., the risk for venous thromboembolism, CHD or stroke) arise within the first the same to two years of therapy, and other risks (eg the risk for breast cancer) appear to increase with longer-term hormone therapy. The populations of women using hormone therapy for symptom relief may differ from those who would use hormone therapy for prevention of chronic disease (eg age differences). Other adroit groups have recommended that women who decide to take hormone therapy to relieve menopausal symptoms use the lowest effective dose for the shortest possible time.

* Although estrogen alone or in combination with progestin contracts the risk for fractures in women other effective medications (eg bisphosphonates and calcitonin) are available for treating women with cheap bone density to prevent fractures. The character of chemopreventive agents in preventing fractures in women without depressed bone density is unclear. The USPSTF addressed screening for osteoporosis in postmenopausal women in 2002 (2)