Hormone Replacement Therapy Still Too Risky, U.S. Panel Says

A U.S. task force is once again recommending postmenopausal women avoid hormone replacement therapy (HRT) -- roughly a decade after its original findings suggested HRT posed significant health risks, including stroke and breast cancer. Monday’s announcement in the Annals of Internal Medicine follows a recent report in the British Medical Journal suggesting HRT offers certain health benefits.

The use of HRT to prevent chronic conditions such as heart disease, dementia and osteoporosis dropped sharply a decade ago, following the results of the Women's Health Initiative (WHI) study. Since that time, the task force analyzed 51 reports from nine different trials published between January 2002 and November 2011. The panel confirmed its earlier findings, noting that the risks of the therapies outweigh benefits. Estrogen plus progestin and estrogen alone moderately reduced the risk for bone fractures but increased the risk for stroke, thromboembolic events (deep vein blood clots), gallbladder disease and urinary incontinence. Estrogen plus progestin increased the risk for breast cancer and dementia, while estrogen alone decreased the risk for breast cancer.

The recommendations apply to average-risk women who have undergone menopause, and not to the use of hormone therapy to treat symptoms of menopause, such as hot flashes.

The report conflicts with a recent study in the British Medical Journal, which suggest that age may play a role in the effects of HRT. In their study of more than 1,000 Danish women who had recently entered menopause, researchers found that women treated with long-term HRT early after menopause "had significantly reduced risk of mortality, heart failure, or myocardial infarction [heart attack], without any apparent increase of cancer, venous thromboembolisms [DVT] or stroke." However, they stress that "due to the potential time lag longer time may be necessary to take more definite conclusions."

In its statement Monday, the U.S. task force noted that its findings are based on trials enrolling older women who were years past menopause, and more research is needed involving women who are transitioning through menopause or who are immediately postmenopausal.