HORMONES -
HRT & QUALITY OF LIFE

Original article:
http://my.webmd.com/content/Article/64/72406.htm

Small Differences Seen in Physical Functioning, Pain, and Sleep

May 7, 2003 -- A cloud of confusion has surrounded HRT since last July, when women learned that hormones are linked to heart disease, breast cancer, and strokes. Now, researchers reveal that HRT does little to improve quality of life.

Their conclusion: Unless you need relief of menopausal symptoms, there's no benefit of HRT on quality of life. The benefit of progestin-estrogen therapy must be weighed against the risk of such therapy for each individual.

Their study appears in the May 8 edition of The New England Journal of Medicine and was released early on March 14 because of the importance of the findings. This study follows on the heels of research released last summer -- in a study called the Women's Health Initiative (WHI) -- in which researchers reported an increased risk of heart attack, breast cancer, and stroke in women taking the combination progestin-estrogen therapy. Those findings prompted the National Institutes of Health to halt the study nearly three years early.

Today's message: "For the vast majority of women, hormones do not change quality of life," lead researcher Jennifer Hays, MD, director of the Center for Women's Health at Baylor College of Medicine in Houston, told WebMD when the study results were first released in March.

In this study, Hays and colleagues analyzed information on all 16,608 postmenopausal women -- all between 50 and 79 years old -- who had randomly been assigned to take either daily progestin-plus-estrogen therapy or placebo.

After one year, women were asked questions about their general health, mental and physical health, limitations due to their physical or emotional health, bodily pain, energy and fatigue, social functioning, depression, memory, sleep disturbance, and satisfaction with sexual functioning.

The results "shocked" Hays and her colleagues. "The differences between the two groups were almost imperceptible," she said. Only small differences in physical functioning, bodily pain, and sleep disturbances in women taking daily combination hormone replacement were found.

Researchers also analyzed data on quality of life in subgroups of women -- those who were youngest (between ages 50 and 59) and most likely to have menopause-related symptoms, and those who had reported the most severe hot flashes.

When looking at just the group of women aged 50-59, no substantial quality-of-life improvements were seen whether or not women had taken HRT.

When looking at all women who reported moderate to severe hot flashes, one year of follow-up did show that 77% of women on HRT improved compared with only half of the women on placebo.

Night sweats also improved significantly in women on the progestin-estrogen therapy.

What happened to their hot flashes? "It's partly placebo effect, but it's also the natural process of menopause," Hays said. "Most women do not experience hot flashes five years after menopause. The symptoms do improve over time."

She pointed out the "tremendous variability" among women in their menopausal experience. Some women simply have worse symptoms -- especially hot flashes -- than others. In fact, one study found women in their 70s who were still having hot flashes, she said.

Many women refused to be enrolled in the WHI study because they wanted to keep taking their hormones. "I heard women say, 'This study is so important, but do not take me off my hormones,'" Hays said. "Whether they could function without the hormones or not is another matter. They had the perception that they couldn't."

"I'm sure many women have benefited from HRT," she told WebMD. "Women seek treatment because their symptoms are severe, very bothersome. So there may be some women these results don't apply to. Those are the women most in need of help. We don't want to invalidate the experience of those women."

More research of this major transition in women's lives is needed, said Hays. "There's no such thing as the average woman. There are variations in physical and emotional experiences during this time."

"You should take hormones if you need them," said Laura Corio, MD, a gynecologist at Mount Sinai Medical Center in New York and author of The Change Before The Change: Everything You Need to Know to Stay Healthy in the Decade Before Menopause.

"If you're having night sweats, hot flashes -- terrible symptoms -- you should take them to relieve symptoms," Corio told WebMD when the study results were first released. However, don't take them longer than necessary. "We're not keeping patients on combined therapy long term if there's no reason."

Quality of life is dependent on exercise, diet, and vitamins, Corio said. "You don't take these hormones to give yourself energy and get better quality of life. They help more with hot flashes, joint pain, mood swings related to hormone changes. If depression is the problem, you need an antidepressant."

Other hormones can also help menopausal women. Natural progesterone can help build bone, help heart and brain, and help sleep disturbance, said Corio. Testosterone helps with energy, mood, libido, and memory.

Hays said her study's findings should be reassuring to women who discontinued estrogen therapy this past summer because they were worried about the risks. Menopause relief often usually comes naturally, she said. "If you hang in there, you will feel better."

SOURCES: The New England Journal of Medicine, May 8, 2003. Jennifer Hays, MD, director, Center for Women's Health, Baylor College of Medicine, Houston. Laura Corio, MD, gynecologist, Mount Sinai Medical Center, New York; author, The Change Before The Change: Everything You Need to Know to Stay Healthy in the Decade Before Menopause.