National Task Force Cautions Against Combined Hormone Replacement Therapy for Women

10/15/02    Portland, Ore.

OHSU researchers provided evidence reports to the Task Force

The U.S. Preventive Services Task Force today recommended against the use of combined estrogen and progestin hormone replacement therapy for preventing cardiovascular disease and other chronic conditions in postmenopausal women. The combination is one form of hormone replacement therapy. The Task Force also concluded that the evidence is insufficient to recommend for or against the use of estrogen alone to prevent the chronic conditions in postmenopausal women who have had hysterectomies.

The Task Force is the leading independent panel of private-sector experts in prevention and primary care. It conducts rigorous, impartial assessments of all scientific evidence.

The Task Force based its conclusion on a report from a team led by OHSU researchers Heidi Nelson, M.D., M.P.H., and Linda Humphrey, M.D., M.P.H., from their reports published in the Aug. 20 edition of Annals of Internal Medicine and another in the Aug. 21 issue of the Journal of the American Medical Association. The reports found that the harms could exceed the benefits for women taking combined estrogen and progestin for five years or longer to prevent chronic conditions. The reviews were not able to determine whether the harms or benefits depended on types of hormones used. Nelson and Humphrey are associate professors of medicine in the OHSU School of Medicine.

"Our group critically reviewed all of the studies reporting major benefits and harms, and then conducted statistical analysis of many of these," said Nelson, who is co-director of the Evidence-Based Practice Center at OHSU. We require more information about the benefits and harms of estrogen use without addition of progestins in order to make a more conclusive statement about its use. It's also important that women and their clinicians read the full recommendations of the Task Force to appropriately consider their decision about HRT use.

"When we evaluated the relationship between HRT use for postmenopausal women and cardiovascular disease, we found no cardiovascular benefit," Humphrey said. "In addition, near the completion of our review, the Women's Health Initiative findings were reported and clearly showed an increased risk of stroke and coronary heart disease among women taking combined estrogen and progestin hormone replacement therapy."

The Women's Health Initiative (WHI) in July halted its clinical trial on the use of combined estrogen-progestin HRT due to higher reports of cardiovascular events and breast cancer.

For many women picking the right therapy for menopause and postmenopause can be confusing. "The appropriate thing for a woman to do is to talk to her physician about her specific health conditions," advised Joanna Cain, M.D., professor and chairwoman of obstetrics and gynecology in the OHSU School of Medicine and director of the OHSU Center for Women's Health.

The Task Force, sponsored by the Agency for Healthcare research and Quality, found evidence for both benefits and harms of combined estrogen and progestin therapy. However, it concluded that harmful effects of the combined use of the hormones are likely to exceed the chronic disease prevention for most women, according to the Agency for Healthcare Research and Quality press release.

The National Institutes of Health has scheduled a scientific workshop on Oct. 23 - 24 that will review the results from components of the WHI clinical trial and what the study results mean for women who are taking combined hormone replacement therapy.

Nelson will be giving two presentations at the workshop. One is an update of a project comparing the effects of two kinds of estrogen on hot flashes, the other will be a presentation of the evidence used for the Task Force recommendation.

OHSU faculty investigating hormone replacement therapy and related issues include:

Heidi Nelson, M.D., M.P.H., associate professor of medicine (medical informatics and outcomes research) in the OHSU School of Medicine and co-director of the Evidence-Based Practice Center at OHSU

Linda Humphrey, M.D., M.P.H., associate professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine and the Portland Veterans Affairs Medical Center

Rodney F. Pommier, M.D., associate professor of surgery in the OHSU School of Medicine, principal investigator of a study involving 300 breast cancer patients at OHSU. The recent study found that women who use HRT have less aggressive tumors and are more likely to be diagnosed through mammograms than other methods.

Cynthia Bethea, Ph.D., adjunct professor of physiology and pharmacology in the OHSU School of Medicine, and senior scientist at OHSU's Oregon National Primate Research Center, studies ovarian steroid action in serotonin neural system of primates.

Kenneth Burry, M.D., professor of obstetrics and gynecology in the OHSU School of Medicine, for the past 25 years has conducted studies on different therapies for the treatment of menopausal symptoms. The studies have included various compounds including different forms of estrogen, progestin and different routes of administration.

Leon Speroff, M.D., professor of obstetrics and gynecology in the OHSU School of Medicine and director of the Women Health Research Unit that conducts clinical trials in HRT.

SuEllen Toth-Fejel, Ph.D., assistant research professor of surgery, (surgical oncology) in the OHSU School of medicine, researcher in the field breast cancer and hormone replacement therapy.

Jill Miller, M.D., assistant professor of medicine (general internal medicine and geritarics), and assistant professor of obstetrics and gynecology, in the OHSU School of Medicine and the OHSU Center for Women's Health, studies postmenopausal estrogen replacement.

Joanna Cain, M.D., professor and chairwoman of obstetrics and gynecology in the OHSU School of Medicineand director of the OHSU Center for Women's Health, can speak on hormone replacement therapy studies and the HRT's relationship to cancers.

The full recommendation by the U.S. Preventive Services Task Force is available on the AHRQ Web site at: http://www.ahrq.gov/clinic.3rduspstf/hrt/hrtrr.htm

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