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HRT Does Little for Quality of Life

Small Differences Seen in Physical Functioning, Pain, and Sleep
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WebMD Health News

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 TheNew 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."

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