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More Experts Oppose Combined HRT

Estrogen, Progestin Combo Should Not Be Used to Prevent Disease

WebMD Health News

Oct. 21, 2002 -- The U.S. Preventive Services Task Force today recommended against the use of the most common form of hormone replacement therapy to prevent chronic conditions such as heart disease and osteoporosis. This comes on the heels of other organizations also steering women and their doctors away from use of this type of HRT for disease prevention.

The Task Force concluded that the harm from combined HRT -- estrogen plus a progestin -- outweighs any potential for benefit against disease prevention. Women who have not had a hysterectomy and are on HRT take this type of combined treatment -- rather than estrogen alone, which increases the chances of getting uterine cancer.

Since a large women's health study was stopped in July, there has been a flurry of discussion about the safety of HRT. In that study, researchers warned that women should stop taking a popular form of HRT. The warning applies to Prempro as well as to other oral, high-dose combinations of estrogen and progestin.

In years past, HRT was thought to help prevent some of the biggest killers of women -- especially heart disease. However, after the study this past summer showed that women on combined HRT were more likely to die of heart disease, more experts have come out against the use of HRT to help prevent chronic disease.

In fact, a panel of medical experts who presented at The North American Menopause Society meeting earlier this month in Chicago had similar feelings about combined HRT. Specifically, the panel's recommendations were:

  • Symptom relief should be the primary reason for taking hormone replacement therapy.
  • Progestins should be added to estrogen therapy only to prevent endometrial cancer. If a woman has had a hysterectomy, there is no need for progestins in her hormone therapy.
  • Hormone therapy should not be used to prevent heart disease; women should take other measures to reduce that risk.
  • Hormone therapies have been shown to help build stronger bones; however, women should weigh the risks of hormone therapy before taking it to prevent osteoporosis.
  • A woman should take HRT for the shortest amount of time possible, based on her symptoms, the benefits she's getting from the therapy, and her personal health risks.
  • Doctors should consider prescribing low-dose HRT whenever possible.
  • Doctors should consider alternate ways of giving HRT other than orally -- such as patches and creams, but should know that studies are not clear on the long-term risks and benefits.
  • Every woman's personal health risks should be evaluated before any form of hormone therapy is prescribed. Women should be sure they understand the known risks.

The Task force did not find sufficient evidence to recommend for or against estrogen only in women who have had a hysterectomy.

In addition, not enough is known about low-dose estrogen/progestin combinations to know if they are safer.

"These recommendations reflect the scientific evidence concerning the long-term effect of HRT, but there are no easy answers for women," says Task Force Chairman Alfred Berg, MD, MPH, in a news release. "It is, therefore, especially important that women talk to their clinicians to decide what is best for them," adds Berg, professor and chair, department of family medicine, University of Washington, Seattle. -->

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