Hormone therapy's quality of life effects mixed

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Hormone therapy's quality of life effects mixed

By Mulvihill

NEW YORK, Feb 05 (Reuters Health) - How hormone replacement therapy

(HRT) affects a woman's overall quality of life is largely related to

whether or not she is experiencing menopausal symptoms at the time the

treatment is started, study findings suggest.

Women who are not experiencing postmenopausal symptoms such as hot

flashes, yet opt for hormone replacement therapy, may experience a

decrease in physical functioning and no improvement in mental health,

researchers report in the February 6th issue of The Journal of the

American Medical Association.

Currently, experts estimate that 38% of US women aged 50 to 74 take some

form of HRT, and their reasons for doing so are multi-faceted, according

to lead author Dr. Mark A. Hlatky of Stanford University in California.

While millions of women choose HRT to reduce menopausal symptoms, many

also use it as a preventative therapy to reduce their risk of heart

disease or the bone-thinning condition osteoporosis. And many women are

swayed by a widespread belief that postmenopausal hormones have general

positive effects on the health of older women, according to the study.

Still, HRT is not without controversy, with some studies reporting that

the regimen does not protect women from developing cardiovascular

disease and may slightly increase their breast cancer risk.

Nevertheless, very few studies have attempted to gauge HRT's effects on

quality-of-life issues--including energy levels, depression and physical

functioning--especially when prescribed for disease prevention, Hlatky

notes.

In their 3-year study, the research team set out to investigate how

hormone replacement therapy impacts a woman's quality of life, if at

all.

To do this, the researchers gave hormone replacement therapy--a

combination of 0.625 milligrams per day of equine estrogen and 2.5 mg

per day of medroxyprogesterone--to 1,383 women whose average age was 67

years. A second group of similarly aged women took an inactive (placebo)

pill. All of the women had been diagnosed with heart disease.

" The major finding is that the effect of a therapy on quality of life

depends on whether someone has symptoms that are likely to improve with

treatment, " said Hlatky in an interview with Reuters Health.

" In our study, women with menopausal symptoms (for example, hot flashes)

had generally better quality of life, " he said. " In contrast, women

without symptoms had generally worse quality of life. "

" While these effects were not dramatic, they were definitely present, "

he added.

Specifically, the authors report that women with hot flashes who

received HRT had improved mental health and fewer depressive symptoms

after 3 years of treatment compared with women who took a placebo. Women

without postmenopausal symptoms who received HRT had greater declines in

physical functioning, as well as fatigue after 3 years.

In an interview with Reuters Health, Hlatky pointed out that the study

has greater implications for women who take HRT for disease prevention.

" The reason this is important is that lots of therapies now are

preventive in nature--they don't aim to treat symptoms. Instead they aim

to reduce risk of future disease, " Hlatky explained.

" Treatment of high blood pressure or high cholesterol are good

examples--neither causes symptoms, and the treatments may have side

effects and make people feel a bit worse...and this may act as a barrier

to their taking their medications, " Hlatky added.

In an accompanying editorial, Drs. M. Rexrode and JoAnn E.

Manson of Harvard Medical School in Boston, Massachusetts, note that the

study " only strengthens the clinical recommendations " that HRT should be

avoided or considered as a secondary option among women with heart

disease.

In addition, " the study by Hlatky (and colleagues) should challenge the

widely held belief that hormone therapy helps women remain more

youthful, active or vibrant, " the editorialists add.

" At present, for women without symptoms of menopause, their quality of

life is not likely to improve with hormone therapy, although they may

reduce the risk of osteoporosis, " Hlatky said.

" Women should discuss the decision to take hormone therapy with their

doctors, " he added.

SOURCE: The Journal of the American Medical Association

2002;287:591-597, 641-642.