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Progestin-Estrogen Therapy Debate Cools

Other Than Treating Menopause Symptoms, HRT Does Little to Improve Quality of Life
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WebMD Health News

March 17, 2003 -- A cloud of confusion has surrounded HRT since last July, when women learned that hormones may cause health risks. Now, in an early release of more findings, researchers reveal that HRT does little to improve quality of life.

Their conclusion: Unless you need relief of menopausal symptoms, there's no benefit to taking combination progestin-estrogen therapy. 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 TheNew England Journal of Medicine, accessed online on March 14. It is the second report issued since Women's Health Initiative (WHI) researchers reported an increased risk of heart attack, breast cancer, and stroke in women taking the combination progestin-estrogen therapy. Those findings prompted the NIH 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, tells WebMD.

In this second 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 says. 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 younger women, no substantial quality-of-life improvements were seen whether or not women had taken HRT.

When looking at 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 explains. "Most women do not experience hot flashes five years after menopause. The symptoms do improve over time."

She points 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 says.

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