Experts: Hormone Therapy Shouldn't Be Used to Prevent Disease After Menopause

In a draft recommendation statement, the United States Preventive Services Task Force (USPSTF) is recommending that healthcare providers do not prescribe combined hormone replacement therapy (HRT) to prevent chronic conditions in post-menopausal people or estrogen-only HRT in people who have had their uterus removed.

The guidance isn’t new—the USPSTF previously recommended against the use of HRT to prevent chronic conditions in post-menopausal people. The recommendation was up for review as part of the USPSTF’s efforts to keep its guidance current and be transparent about its process.

The USPSTF clarified that the updated recommendation does not apply to people who want to use HRT to treat the symptoms of menopause, people in premature menopause, or people in surgical menopause.

What Is HRT?

A person with ovaries gets older, the ovaries gradually stop making estrogen and progesterone. Without these hormones, they will eventually no longer get their menstrual period. Once this occurs, they have entered menopause.

Hormone replacement therapy (HRT) is a medical treatment that can help relieve the symptoms of menopause and those that happen in the transition phase leading up to it (perimenopause).

There are two types of HRT:

• Estrogen only: Estrogen is the hormone responsible for the development and regulation of the female reproductive system. It is the main hormone used in HRT.
• Estrogen plus progestin: Progestin is a human-made version of progesterone. It is included in HRT to lower the risk of reproductive cancer that’s associated with using estrogen-only HRT. Progestin may also help relieve hot flashes.

There are different forms of HRT that are used to treat symptoms of menopause:

• Systemic estrogen therapy: This form of therapy uses pills, skin patches, gels, and sprays to release estrogen into the bloodstream.
• Local estrogen therapy: This type of treatment is typically used by people who have vaginal dryness. It comes in the form of a vaginal ring, tablet, or cream that releases small doses of estrogen directly into the vaginal tissue.

HRT with progestin can be taken in pills or tablet form, or as gels that are placed in the vagina. Some people can also use an intrauterine device (IUD) that releases progestin.

Using HRT to Prevent Chronic Conditions

Jennifer Wider, MD, women’s health expert, told Verywell that HRT “has been part of the therapeutic options to treat chronic conditions for a long time. The thought is that it could be used successfully to prevent and lower the risk for diabetes, bone fracture and osteoporosis; and certain types of cancer.”

For example, HRT might be prescribed to help lower a person’s risk of developing:

• Heart disease
• Stroke
• Osteoporosis
• Blood clots (thromboembolism)
• Dementia and cognitive function problems
• Breast, colon, ovarian, and endometrial cancers
• Diabetes
• Cholecystitis

Gloria A Bachmann, MD, associate dean for women’s health at Rutgers Robert Wood Johnson Medical School, told Verywell that “since many health-related conditions are age-related—and the menopausal transition usually occurs in women in their mid-40s to mid-50s—it can be inferred that perhaps these age-related health conditions are due to the loss of estrogen.”

However, Wider added that some studies have shown HRT may “increase the risk of diseases like gallbladder disease, breast cancer, and stroke in certain people.”

HRT Should Not Be Used to Prevent Post-Menopausal Conditions

There is a lack of data to support the use of HRT in post-menopausal people for conditions unrelated to menopause—which concerns a lot of providers.

Arashdeep K. Litt, MD, a board-certified internal medicine physician, told Verywell that “anything used with a lack of data will cause more harm for some high-risk patients.”

According to Bachmann, HRT “should only be used when there is an indication for its use that has been confirmed by medical research.”

Bachmann said that the USPSTF group “has carefully looked at all of the research information available on hormonal therapy and has found that there is not enough evidence to support that hormonal therapy should be used to prevent chronic conditions in postmenopausal women.”

Litt agreed, adding that HRT “has no proven benefit for prevention of chronic conditions like osteoporosis or heart disease and is not indicated for such conditions.”

If you’re worried about developing certain health conditions after menopause, there are still ways that you can reduce your risk.

“Definitely check in with your own healthcare provider,” Wider said. “Certain people are at higher risk for certain diseases and it is not a one-size-fits-all prescription.”

In fact, Wider added that “it may be smart to avoid hormones in the prevention of chronic conditions—especially if you have a personal or family history of certain diseases.”