These are the instant U.S. Prevent...

These are the instant U.S. Preventive Services Task Force (USPSTF) recommendations for use of hormone replacement therapy (HRT) for the primary prevention of chronic conditions in postmenopausal women This statement updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, secondary edition. (1) Explanations of the ratings and of the puissance of overall evidence are given in Tables 1 and 2 respectively. The perfect information on which this statement is based, including evidence tables and respects is available in the summary of the evidence, "Postmenopausal Hormone Replacement Therapy for the Primary Prevention of Chronic Conditions." (2) The USPSTF recommendations and individual reports onward HRT and specific disease consequences are available on the USPSTF Web site (www.preventiveservices.ahrq.gov) and between the sides of the National Guideline Clearinghouse (www.guideline.gov).

The USPSTF reviewed the evidence forward the use of postmenopausal HRT and the following outcomes: cardiovascular disease, including coronary heart disease (CHD) and stroke; osteoporosis and fractures; thromboembolism; dementia and cognitive function; breast, colon ovarian, and endometrial cancers; and cholecystitis. The USPSTF also reviewed evidence of the validitys of HRT on phytoestrogens, osteoporosis, and cardiovascular disease. The use of HRT for relieving active symptoms of menopause, like as hot flashes, urogenital symptoms, and disposition and sleep disturbances, among others, is outside the room of these USPSTF recommendations, and literature in succession this topic was not reviewed. Sources for estimates of benefits and harms cited in this statement are described in the summary of the evidence. (2)

Summary of Recommendations

* The USPSTF attract favor tos against the routine use of estrogen and progestin for the prevention of chronic conditions in postmenopausal women D recommendation.

The USPSTF build fair to good evidence that the combination of estrogen and progestin has the one and the other benefits and harms. Benefits include increased bone mineral density (good evidence), reduc risk for fracture (fair to advantageous evidence), and reduced risk for colorectal cancer (fair evidence). Harms include increased risk for breast cancer (good evidence), venous thromboembolism (good evidence), CHD (fair to worthy evidence), stroke (fair evidence), and cholecystitis (fair evidence). Evidence was insufficient to assess the validitys of HRT on other important issues such as dementia and cognitive function, ovarian cancer, mortality from breast cancer or cardiovascular disease, or all-cause mortality.

* The USPSTF conclud that the harmful issues of estrogen and progestin are likely to exce the chronic disease prevention benefits in principally women. The USPSTF did not evaluate the use of HRT to treat symptoms of menopause, like as vasomotor symptoms (hot flashes) or urogenital symptoms. The balance of benefits and harms for an individual woman will be influenced through her personal preferences, individual risks for specific chronic diseases, and the demeanor of menopausal symptoms.

* The USPSTF deduces that the evidence is insufficient to praise for or against the use of unopposed estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. I recommendation.

The USPSTF fix fair to good evidence that the use of unopposed estrogen has one as well as the other benefits and harms. Although mostly current data come from observational studies, likely benefits include increased bone mineral density, reduc fracture risk, and reduc risk for colorectal cancer. Likely harms include increased risk for venous thromboembolism, cholecystitis, and stroke; in women who have not had a hysterectomy, unopposed estrogen increases the risk for endometrial cancer. Evidence is insufficient to determine the results of unopposed estrogen on the risk for breast and ovarian cancer, CHD dementia and cognitive function, or mortality. As a proceed the USPSTF could not determine whether the benefits of unopposed estrogen outweigh the harms for women who have had a hysterectomy. Better data upon benefits and harms are awaited from ongoing randomized trials, including the Women's Health Initiative (WHI) research of unopposed estrogen in women who have had a hysterectomy. (3)

Clinical Considerations

* Although the USPSTF judges that the harms of estrogen-progestin therapy are likely to outweigh the chronic disease prevention benefits for mostly women, the absolute increase in risk from HRT is unostentatious Some women, depending on their risk characteristics and personal predilections might decide that the benefits of taking HRT outweigh the potential harms. Based upon results reported from the WHI close attention (3) for women aged 50 to 79 years (average age, 63 years), 10000 women taking estrogen and progestin for united year might experience seven additional CHD marked occurrences eight more strokes, eight more pulmonary emboli, and eight more invasive breast cancers, still also would have six fewer cases of colorectal cancer and five fewer hip fractures.