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Health-related quality of life improved with HT after menopause
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Postmenopausal hormone therapy users experienced small but significant improvements in vasomotor symptoms, sexual function and sleep problems after one year of treatment compared with placebo.
Combined HT started many years after menopause can improve health-related quality of life, according to the researchers. They arrived at this finding after comparing the effect of combined HT — conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 2.5 mg or 5 mg — with placebo among women enrolled in the WISDOM trial. They randomly assigned 3,721 postmenopausal women aged 50 to 69 years to a treatment or a placebo group and used health questionnaires to determine health-related quality of life and psychological well-being.
At baseline, 30% of women assigned to HT reported hot flashes compared with 29% of women assigned to placebo. Prevalence of hot flashes decreased to 9% among women taking HT and 25% among those taking placebo after one year.
Night sweats, aching joints and muscles, insomnia and vaginal dryness also were less common among women taking HT compared with those taking placebo (P<.001). However, these women experienced greater frequency of breast tenderness and vaginal discharge. The researchers reported no significant between-group differences in other menopausal symptoms, depression or overall quality of life. – by Katie Kalvaitis
BMJ. 2008;337:a1190.
It is difficult to define what quality of life means to menopausal women. Various menopause-related quality of life instruments have been developed, with major focus on sleep disturbance, frequency and intensity of hot flashes and hormonal changes as they affect physical and emotional functioning or bodily pain. Study results have been mixed regarding improvement of quality of life with HT. The re-analysis of the Women’s Health Initiative was reassuring for those women aged younger than 60 years within 10 years of menopause who had significant vasomotor symptoms and no contraindications to HT. The WISDOM trial, which was halted early because of the release of early Women’s Health Initiative results, provided short-term reassurance for symptomatic women that HT may improve hot flashes, joint and muscle aching and vaginal dryness with potential side effects such as breast tenderness and bleeding, and thus is an option to be discussed. Potential risks exist, including risk for stroke, blood clot, breast cancer and, for older women, CV concerns or increased risk for dementia. Alternatives to HT exist, such as antidepressants and gabapentin, but none are FDA approved for treatment for moderate-to-severe vasomotor symptoms.
– JoAnn V. Pinkerton, MD
Director, Midlife Health Center, University of Virginia