Counseling Guidelines: HRT Risks and Benefits
Counseling Guidelines: HRT Risks and Benefits
The American College of Physicians in Philadelphia analyzed data hormone therapy studies from 1970-1992. Input was obtained from internists, gynecologists, endocrinologists, geriatricians, cardiologists, oncologists, and family physicians. Using the findings, it developed guidelines for women’s health pro- fessionals to use in counseling and in designing treatment plans.1,2 The guidelines present outcomes for:
1. Unopposed estrogen therapy: Daily doses of 0.625 mg of oral conjugated estrogen.
2. Combined estrogen and progestin therapy: Combinations of estrogen and progestin in cyclic or combined daily regimens.
Here are highlights of the report:
• Reduction in coronary artery disease. Unopposed estrogen: 35% risk reduction. Combined therapy: Insufficient evidence for conclusions.
• Osteoporosis-related fractures. Unopposed estrogen: 25%. Combined therapy: Probably protects, though evidence is limited.
• Life expectancy. Unopposed estrogen: General increase by reducing osteoporotic fracture and heart disease risks. Combined therapy: Possible increase by reducing osteoporotic fracture and heart disease risks, but perhaps not as much as unopposed estrogen. Possible decrease life expectancy for women with high breast cancer risk.
• Strokes. Unopposed estrogen: No convincing evidence for increased or decreased risk. Combined therapy: No information available.
• Endometrial cancer. Unopposed estrogen: Over 10 to 20 years of use, eight-fold increase in risk; high cure rate for endometrial cancers in estrogen users. Combined therapy: No increase in risk.
• Breast cancer. Unopposed estrogen: Extensive but inconsistent evidence. For estrogen use less than five years, probably no increased risk; for use 10 to 20 years, apparent 25% increase. Combined therapy: Limited and inconsistent evidence. Long term use, 25% increase.
• Probability of needing hysterectomy. Unopposed estrogen: For women with uterus, 20% increased probability. Combined therapy: No apparent probability.
References
1. AGS Clinical Practice Committee. Counseling postmenopausal women about preventive hormone therapy. J Am Geriatr Soc 1996; 44:1,120-1,122.
2. American College of Physicians. Guidelines for counseling postmenopausal women about preventive hormone therapy. Ann Intern Med 1992; 117:1,038-1,041.
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