HRT Improves Quality Of Life For Some

Editor's Choice
Main Category: Menopause
Also Included In: Cardiovascular / Cardiology;  Breast Cancer
Article Date: 23 Aug 2008 - 0:00 PDT

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A new study published on bmj.com argues that for older women, health related quality of life can be improved by hormone replacement therapy (HRT). The authors recommend that HRT guidelines should be revised with this most current evidence taken into consideration.

Earlier studies have shown that HRT has the potential for general improvements in quality of life measures - how patients feel or function. The therapy has also been successful in reducing the number and severity of symptoms related to menopause. However, a weakness in these studies is that the researchers have used general measures rather than more sensitive condition specific ones.

To add to the body of research dealing with health related quality of life, Professor Alastair MacLennan and colleagues study outcomes of participants in the WISDOM trial - a 10-year study beginning in 1999 that focuses on long-term benefits and risks of HRT in postmenopausal women. The WISDOM trial sample consisted of 5,692 healthy women between the ages of 50 and 69 from the UK, Australia, and New Zealand who were randomly assigned to receive either combined HRT (estrogen and progestogen) or placebo. On average, women were followed-up for about 12 months so researchers could test clinical outcomes such as cardiovascular disease, fractures, and breast cancer. In addition, the women provided detailed information on how HRT impacted their quality of life.

The quality of life measurement was derived from questionnaire responses targeted towards physical and emotional components of health (depressed mood, memory, and concentration), sleep problems, and sexual functioning. Also included was a symptoms questionnaire.

MacLennan and colleagues found that after one year, women in the combined HRT group saw significant improvements in sexual functioning, sleep problems and vasomotor symptoms (hot flushes and sweats) compared to women in the placebo group. More specifically, women in the HRT group reported:

• Fewer hot flushes (9% v 25%),
• Fewer night sweats (14% v 23%),
• Less aching joints and muscles (57% v 63%),
• Less insomnia (35% v 41%),
• Less vaginal dryness (14% v 19%),
• More breast tenderness (16% v 7%), and
• More vaginal discharge (14% v 5%).
  

There were no significant differences between other menopausal symptoms, depression, and overall quality of life between the two groups.

Although these results are similar to the findings of the Women's Health Initiative (WHI) - HRT use reduced hot flushes and night sweats, improved sleep, and eased bodily pain, the WISDOM trial was in fact halted early since the WHI found that elderly women taking HRT had more heart attacks than non-HRT users. These leads the researchers to caution that health related quality of life should be weighed against the risk of increased cardiac events, venous thromboembolism and breast cancer that are associated with HRT.

Health related quality of life after combined hormone replacement therapy: randomised controlled trial
Amanda J Welton, Madge R Vickers, Joseph Kim, Deborah Ford, Beverley A Lawton, Alastair H MacLennan, Sarah K Meredith, Jeannett Martin, Tom W Meade for the WISDOM team
BMJ (2008). 337: a1190.
doi:10.1136/bmj.a1190
Click Here to View Journal Web Site

Written by: Peter M Crosta
Copyright: Medical News Today
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