There is insufficient evidence to make a generalized recommendation for or against Hormone Replacement Therapy (HRT) use by all menopausal women. Physicians should consistently address the potential risks and benefits of HRT with all perimenopausal female patients and arrive at a decision compatible with the patient’s risk-factor profile and subjective preferences. Once a decision is reached to start HRT, estrogen alone is recommended in women of post-hysterectomy status, while combination therapy with estrogen and progesterone is recommended in women with an intact uterus. Women with coronary risk factors (hypertension, lipid abnormalities, and/or family history of heart disease) may benefit from HRT even if they have a family history of breast cancer. However, modification of cardiac risk factors by alternative means can also be considered in this group. The results of HERS suggest that HRT should be avoided or used cautiously in women with known coronary disease; whether this pertains to estrogen alone, or exclusively to the combination of estrogen and progesterone, remains to be elucidated. For patients with a personal history of breast cancer and/or thromboembolic disease, alternative means of reducing risk for osteoporosis and cardiovascular disease should be considered. The importance of adhering to recommended screening protocols for breast cancer should be stressed. The role of newer synthetic estrogens has not yet been adequately studied, but preliminary evidence is favorable. Such agents may be particularly appropriate in women who have cardiac or osteoporosis risk factors, but are unwilling to accept the breast cancer risk associated with conventional HRT. Current evidence favors indefinite use of HRT once initiated, but the risks of therapy over a period of decades have not been well studied. The decision to use HRT should be revisited at regular intervals in the light of both new data from randomized trials and the patient’s response to therapy.

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The Task Force recommends against the routine use of estrogen and progestin for the prevention of chronic conditions in postmenopausal women (D recommendation).

The USPSTF concludes that the evidence is insufficient to recommend for or against the use of unopposed estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy (I recommendation).