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Do Postmenopausal Women Who Take HT Feel Better . . . or Worse?

This important study of HERS participants suggests that HT improves quality of life among those with vasomotor symptoms, but does not improve it among those without vasomotor symptoms.

To determine the effect of postmenopausal hormone therapy (HT) on quality of life, these authors analyzed data on 2763 women (mean age, 67) with pre-existing coronary artery disease (CAD) who were enrolled in the Heart and Estrogen/progestin Study (HERS), a manufacturer-supported, randomized, placebo-controlled, double-blind trial. In the present study, which was manufacturer-supported and federally funded, the authors compared quality-of-life indices in participants randomized to either HT (0.625 mg of conjugated estrogen and 2.5 mg of medroxyprogesterone acetate) or placebo. Physical function, energy/fatigue, mental health, and depressive symptoms were assessed by questionnaire at baseline and at 4 additional times during the 3-year follow-up.

Physical function, mental health, and energy/fatigue scores decreased significantly from baseline in both the treatment and control groups. Depressive symptoms in both groups did not change during the study. The effect of HT on quality-of-life measurements depended on the presence of vasomotor symptoms at baseline. Of the women with flushing at baseline, HT recipients had greater improvement in mental health and fewer depressive symptoms than did placebo recipients. In contrast, of the women without flushing at baseline, HT recipients had significantly greater declines in physical function and energy/fatigue than did placebo recipients.

Comment: These important findings suggest that, among older postmenopausal women with CAD who do not have hot flashes, HT does not improve, and may even decrease, some aspects of quality of life. In contrast, HT appears to improve quality of life among comparable women with vasomotor symptoms.

Women using HT to relieve menopausal symptoms (e.g., hot flashes) might subjectively respond better to such treatment than do those using HT to address asymptomatic conditions (e.g., declining BMD). In the latter group, side effects of treatment dominate perceptions of therapy. Clinicians who prescribe HT to prevent osteoporosis may need to institute supportive approaches that encourage medication adherence and continuation (e.g., serial measurements of BMD).

HERS participants were older and less healthy than are most menopausal women beginning HT; therefore, these findings may not fully apply to younger, healthier menopausal women, who are more likely to experience vasomotor symptoms than are older women. The Women's Health Initiative has been gathering quality-of-life data that will be more applicable to younger, healthier menopausal women.

— Ann J. Davis, MD, and Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health March 25, 2002

Citation(s):

Hlatky MA et al. Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: Results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial. JAMA 2002 Feb 6; 287:591-7.

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