We have better tools for prevention, but let’s talk!
Should we be offering hormone therapy for primary prevention in postmenopausal patients? Dr. Carol Mangione (UCLA) talks us through the potential benefits and harms, and explains how this can be a jumping off point for important conversations about preventive care.
It looked at conjugated estrogens (Premarin) with or without medroxyprogesterone (Provera)
This recommendation is specifically regarding using hormone therapy to prevent disease, and not at the use of hormone therapy to treat specific health conditions, such as menopausal symptoms
When treating menopausal symptoms, the recommendations are generally using the lowest dose for the shortest period of time (ACOG Practice Bulletin 2014)
Specifically, the USPSTF did not find evidence to support a benefit of cardiovascular disease prevention
There is moderate benefit for reducing fractures, and small benefit in reducing risk of diabetes and colon cancer – BUT, we have safer choices to reduce these risks
It’s worth noting that the participants in the Women’s Health Initiative were somewhat homogeneous
As a result, there is an evidence need to study higher risk groups in the future, such as those that experience systemic racism or poverty
How is this different from the last recommendation?
This is not significantly different from the 2017 recommendation
Guidelines are typically re-examined every five years, and this did allow for longer-term follow up for the outcomes of interest, and included review of several more studies that reinforced this recommendation
How can this be incorporated into practice?
These recommendations can be used to have conversations about the effective tools we have for the prevention of conditions such as cardiovascular disease and colorectal cancer
Listeners will explain the USPSTF recommendation regarding the use of hormone therapy for the primary prevention of chronic health conditions in postmenopausal persons.
After listening to this episode listeners will…
Become familiar with the USPSTF recommendation regarding the use of hormone therapy for the primary prevention of chronic health issues
Describe the theoretical benefits that may be associated with hormone therapy for primary prevention
Recognize the moderate harms associated with chronic hormone therapy use
Utilize these recommendations to have important conversations with their patients regarding evidence-based preventive care
Dr. Mangione reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Gibson E, Williams PN, and Mangione E. “#TBD Hormone Therapy for Primary Prevention of Chronic Conditions Postmenopausal Persons – a USPSTF update with Dr. Carol Mangione”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list January 4, 2023.