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HRT Linked to Shorter but Better-Quality Life

Short-Term Hormone Therapy Can Shorten Life by Weeks but Improve Quality
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WebMD Health News

Aug. 9, 2004 -- It is widely accepted that the risks of using hormone therapy for many years may outweigh the benefits, but what about the risks and benefits of short-term use exclusively for the treatment of menopausal symptoms?

New research suggests that short-term menopausal hormone therapy shortens life expectancy but improves the quality of life for those with mild or severe menopausal symptoms, the study's lead researcher tells WebMD. The findings are published in the Aug. 9/23 issue of Archives of Internal Medicine.

"These women appear to benefit, even if they have a high risk for stroke," Nananda Col, MD, tells WebMD. "Women with moderate symptoms tend to benefit if they have a relatively low risk for heart disease."

WHI Revisited

Two years ago, a large study known as the Women's Health Initiative showed that long-term hormone therapy (for five years or more) increased the risk of heart disease, stroke, blood clots, and breast cancer. The WHI trial included postmenopausal women who were given hormone therapy for reasons other than relief of menopausal symptoms. In this study, women were started on hormone therapy years after menopause. Other studies have suggested that hormone therapy is also associated with an increased risk of heart disease when therapy is first started.

In an effort to clarify the risks vs. the benefits of short-term hormone therapy in younger menopausal women, Col and colleagues developed a computer model to explore the trade-off between short-term symptomatic relief of menopausal symptoms and risk of inducing disease. The model was based on the data from the WHI study.

The study showed that when quality-of-life issues are not considered, the average 50-year-old woman who takes hormone therapy for two years can expect an almost two-week shorter life span. A 50-year-woman at high risk of heart disease would expect a loss of life expectancy of more than five weeks, whereas a women at low risk for heart disease could expect a loss of six days.

But the shortened life expectancy from hormone therapy appeared to be outweighed by the benefits of the treatment in women with menopausal symptoms such as hot flashes.

Women with mild symptoms gained from three to four months of life expectancy and quality of life. The increased expectancy was found in women regardless of their risk of heart disease.

The researchers found that the longer hormones are used to relieve symptoms, the larger the gains in quality of life. According to the model, even women at high risk of heart disease gained more than eight months in quality of life by increasing hormone therapy from two years to five years.

"If the only goal were to maximize survival then nobody should take hormone therapy," Col says. "But for most women who are considering it for symptom relief, quality of life is the main consideration."

While warning that women who have an extremely high risk for heart disease may not be good candidates for the therapy, Col says the benefits of short-term hormone therapy use appear to outweigh the risks for most symptomatic women.

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