[Skip to Content]
[Skip to Content Landing]

Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal PersonsUS Preventive Services Task Force Recommendation Statement

To identify the key insights or developments described in this article
1 Credit CME
Abstract

Importance  Menopause is defined as the cessation of a person’s menstrual cycle. It is defined retrospectively, 12 months after the final menstrual period. Perimenopause, or the menopausal transition, is the few-year time period preceding a person’s final menstrual period and is characterized by increasing menstrual cycle length variability and periods of amenorrhea, and often symptoms such as vasomotor dysfunction. The prevalence and incidence of most chronic diseases (eg, cardiovascular disease, cancer, osteoporosis, and fracture) increase with age, and US persons who reach menopause are expected on average to live more than another 30 years.

Objective  To update its 2017 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of systemic (ie, oral or transdermal) hormone therapy for the prevention of chronic conditions in postmenopausal persons and whether outcomes vary by age or by timing of intervention after menopause.

Population  Asymptomatic postmenopausal persons who are considering hormone therapy for the primary prevention of chronic medical conditions.

Evidence Assessment  The USPSTF concludes with moderate certainty that the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal persons with an intact uterus has no net benefit. The USPSTF concludes with moderate certainty that the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy has no net benefit.

Recommendation  The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal persons. (D recommendation) The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy. (D recommendation)

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Carol M. Mangione, MD, MSPH, David Geffen School of Medicine, University of California, Los Angeles, 10940 Wilshire Blvd, Ste 700, Los Angeles, CA 90024 (chair@uspstf.net).

Accepted for Publication: September 26, 2022.

The US Preventive Services Task Force (USPSTF) Members: Carol M. Mangione, MD, MSPH; Michael J. Barry, MD; Wanda K. Nicholson, MD, MPH, MBA; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; David Chelmow, MD; Tumaini Rucker Coker, MD, MBA; Esa M. Davis, MD, MPH; Katrina E. Donahue, MD, MPH; Carlos Roberto Jaén, MD, PhD, MS; Martha Kubik, PhD, RN; Li Li, MD, PhD, MPH; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; John M. Ruiz, PhD; James Stevermer, MD, MSPH; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) Members: University of California, Los Angeles (Mangione); Harvard Medical School, Boston, Massachusetts (Barry); University of North Carolina at Chapel Hill (Nicholson, Donahue); Albert Einstein College of Medicine, New York, New York (Cabana); Oregon Health & Science University, Portland (Caughey); Virginia Commonwealth University, Richmond (Chelmow); University of Washington, Seattle (Coker); University of Pittsburgh, Pittsburgh, Pennsylvania (Davis); The University of Texas Health Science Center, San Antonio (Jaén); George Mason University, Fairfax, Virginia (Kubik); University of Virginia, Charlottesville (Li); New York University, New York, New York (Ogedegbe); University of Massachusetts Medical School, Worcester (Pbert); University of Arizona, Tucson (Ruiz); University of Missouri, Columbia (Stevermer); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Mangione had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Howard Tracer, MD (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Additional Information: The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Published by JAMA®—Journal of the American Medical Association under arrangement with the Agency for Healthcare Research and Quality (AHRQ). ©2022 AMA and United States Government, as represented by the Secretary of the Department of Health and Human Services (HHS), by assignment from the members of the United States Preventive Services Task Force (USPSTF). All rights reserved.

References
1.
Col  NF , Fairfield  KM , Ewan-Whyte  C , Miller  H .  In the clinic: menopause.   Ann Intern Med. 2009;150(7):ITC4-1-15. doi:10.7326/0003-4819-150-7-200904070-01004PubMedGoogle ScholarCrossref
2.
Harlow  SD , Gass  M , Hall  JE ,  et al; STRAW 10 Collaborative Group.  Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging.   Menopause. 2012;19(4):387-395. doi:10.1097/gme.0b013e31824d8f40PubMedGoogle ScholarCrossref
3.
McKinlay  SM .  The normal menopause transition: an overview.   Maturitas. 1996;23(2):137-145. doi:10.1016/0378-5122(95)00985-XPubMedGoogle ScholarCrossref
4.
Social Security Administration. Actuarial life table: period life table, 2010. Accessed September 2, 2022. https://www.ssa.gov/oact/STATS/table4c6.html
5.
US Preventive Services Task Force. US Preventive Services Task Force Procedure Manual. Published May 2021. Accessed September 2, 2022. https://uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual
6.
Pfizer Inc. Premarin prescribing information. Accessed September 2, 2022. https://labeling.pfizer.com/showlabeling.aspx?id=131
7.
Manson  JE , Chlebowski  RT , Stefanick  ML ,  et al.  Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials.   JAMA. 2013;310(13):1353-1368. doi:10.1001/jama.2013.278040PubMedGoogle ScholarCrossref
8.
Gartlehner  G , Patel  SV , Reddy  S , Rains  C , Coker-Schwimmer  M , Kahwati  L .  Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: An Evidence Review for the US Preventive Services Task Force. Evidence Synthesis No. 222. Agency for Healthcare Research and Quality; 2022. AHRQ publication 22-05294-EF-1.
9.
Gartlehner  G , Patel  SV , Reddy  S , Rains  C , Schwimmer  M , Kahwati  L .  Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. Published November 1, 2022. doi:10.1001/jama.2022.18324Google Scholar
10.
US Preventive Services Task Force.  Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement.   JAMA. 2022;327(16):1577-1584. doi:10.1001/jama.2022.4983PubMedGoogle ScholarCrossref
11.
US Preventive Services Task Force.  Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement.   JAMA. 2021;325(16):1650-1656. doi:10.1001/jama.2021.4987PubMedGoogle ScholarCrossref
12.
US Preventive Services Task Force.  Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement.   JAMA. 2021;326(8):736-743. doi:10.1001/jama.2021.12531PubMedGoogle ScholarCrossref
13.
US Preventive Services Task Force.  Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: US Preventive Services Task Force recommendation statement.   JAMA. 2020;324(20):2069-2075. doi:10.1001/jama.2020.21749PubMedGoogle ScholarCrossref
14.
US Preventive Services Task Force.  Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force recommendation statement.   JAMA. 2017;318(2):167-174. doi:10.1001/jama.2017.7171PubMedGoogle ScholarCrossref
15.
US Preventive Services Task Force.  Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(24):2521-2531. doi:10.1001/jama.2018.7498PubMedGoogle ScholarCrossref
16.
Siu  AL ; US Preventive Services Task Force.  Screening for breast cancer: US Preventive Services Task Force recommendation statement.   Ann Intern Med. 2016;164(4):279-296. doi:10.7326/M15-2886PubMedGoogle ScholarCrossref
17.
US Preventive Services Task Force.  Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238PubMedGoogle ScholarCrossref
18.
US Preventive Services Task Force.  Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: US Preventive Services Task Force recommendation statement.   JAMA. 2017;318(22):2224-2233. doi:10.1001/jama.2017.18261PubMedGoogle ScholarCrossref
19.
Chlebowski  RT , Anderson  GL , Aragaki  AK ,  et al.  Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow-up of the Women’s Health Initiative randomized clinical trials.   JAMA. 2020;324(4):369-380. doi:10.1001/jama.2020.9482PubMedGoogle ScholarCrossref
20.
Prentice  RL , Aragaki  AK , Chlebowski  RT ,  et al.  Dual-outcome intention-to-treat analyses in the Women’s Health Initiative randomized controlled hormone therapy trials.   Am J Epidemiol. 2020;189(9):972-981. doi:10.1093/aje/kwaa033PubMedGoogle ScholarCrossref
21.
LaCroix  AZ , Chlebowski  RT , Manson  JE ,  et al; WHI Investigators.  Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial.   JAMA. 2011;305(13):1305-1314. doi:10.1001/jama.2011.382PubMedGoogle ScholarCrossref
22.
Watts  NB , Cauley  JA , Jackson  RD ,  et al; Women’s Health Initiative Investigators.  No increase in fractures after stopping hormone therapy: results from the Women’s Health Initiative.   J Clin Endocrinol Metab. 2017;102(1):302-308.PubMedGoogle Scholar
23.
Herrington  DM , Reboussin  DM , Brosnihan  KB ,  et al.  Effects of estrogen replacement on the progression of coronary-artery atherosclerosis.   N Engl J Med. 2000;343(8):522-529. doi:10.1056/NEJM200008243430801PubMedGoogle ScholarCrossref
24.
Margolis  KL , Bonds  DE , Rodabough  RJ ,  et al; Women’s Health Initiative Investigators.  Effect of oestrogen plus progestin on the incidence of diabetes in postmenopausal women: results from the Women’s Health Initiative Hormone Trial.   Diabetologia. 2004;47(7):1175-1187. doi:10.1007/s00125-004-1448-xPubMedGoogle ScholarCrossref
25.
Kanaya  AM , Herrington  D , Vittinghoff  E ,  et al; Heart and Estrogen/progestin Replacement Study.  Glycemic effects of postmenopausal hormone therapy: the Heart and Estrogen/progestin Replacement Study: a randomized, double-blind, placebo-controlled trial.   Ann Intern Med. 2003;138(1):1-9. doi:10.7326/0003-4819-138-1-200301070-00005PubMedGoogle ScholarCrossref
26.
Cushman  M , Kuller  LH , Prentice  R ,  et al; Women’s Health Initiative Investigators.  Estrogen plus progestin and risk of venous thrombosis.   JAMA. 2004;292(13):1573-1580. doi:10.1001/jama.292.13.1573PubMedGoogle ScholarCrossref
27.
Veerus  P , Hovi  SL , Fischer  K , Rahu  M , Hakama  M , Hemminki  E .  Results from the Estonian postmenopausal hormone therapy trial.  [ISRCTN35338757].  Maturitas. 2006;55(2):162-173. doi:10.1016/j.maturitas.2006.01.012PubMedGoogle ScholarCrossref
28.
Shumaker  SA , Legault  C , Rapp  SR ,  et al; WHIMS Investigators.  Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial.   JAMA. 2003;289(20):2651-2662. doi:10.1001/jama.289.20.2651PubMedGoogle ScholarCrossref
29.
Shumaker  SA , Legault  C , Kuller  L ,  et al; Women’s Health Initiative Memory Study.  Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women’s Health Initiative Memory Study.   JAMA. 2004;291(24):2947-2958. doi:10.1001/jama.291.24.2947PubMedGoogle ScholarCrossref
30.
Writing Group for the PEPI Trial.  Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial.   JAMA. 1995;273(3):199-208. doi:10.1001/jama.1995.03520270033028PubMedGoogle ScholarCrossref
31.
Steinauer  JE , Waetjen  LE , Vittinghoff  E ,  et al.  Postmenopausal hormone therapy: does it cause incontinence?   Obstet Gynecol. 2005;106(5, pt 1):940-945. doi:10.1097/01.AOG.0000180394.08406.15PubMedGoogle ScholarCrossref
32.
Prentice  RL , Manson  JE , Langer  RD ,  et al.  Benefits and risks of postmenopausal hormone therapy when it is initiated soon after menopause.   Am J Epidemiol. 2009;170(1):12-23. doi:10.1093/aje/kwp115PubMedGoogle ScholarCrossref
33.
 ACOG Committee Opinion No. 565: hormone therapy and heart disease.   Obstet Gynecol. 2013;121(6):1407-1410. doi:10.1097/01.AOG.0000431053.33593.2dPubMedGoogle ScholarCrossref
34.
Hauk  L ; American College of Obstetricians and Gynecologists.  ACOG releases practice bulletin on osteoporosis.   Am Fam Physician. 2013;88(4):269-275.PubMedGoogle Scholar
35.
Shifren  JL , Gass  ML ; NAMS Recommendations for Clinical Care of Midlife Women Working Group.  The North American Menopause Society recommendations for clinical care of midlife women.   Menopause. 2014;21(10):1038-1062. doi:10.1097/GME.0000000000000319PubMedGoogle ScholarCrossref
36.
American Academy of Family Physicians. Clinical Preventive Service Recommendation: hormone replacement therapy. Accessed September 2, 2022. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/hrt.html
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close