Feb. 5, 2002 -- Until recently, hormone replacement therapy was widely considered to be the closest thing to the Fountain of Youth for postmenopausal women. Nearly 40% of American women aged 50 to 74 remain on it in the belief that the treatment relieves the symptoms of menopause and protects them against heart disease and bone-thinning osteoporosis.
Are they right? The jury is still out with regard to osteoporosis and heart disease. But new research suggests that hormone therapy does improve quality of life in women who have menopausal symptoms such as hot flashes when they began treatment. The therapy was found to have a negative impact on quality of life, however, in women who started therapy without such symptoms.
"What we know, or think we know, about hormone replacement therapy has certainly shifted over the last few years," Kathryn M. Rexrode, MD, tells WebMD. "Five or 10 years ago, we believed that the benefits of hormone therapy were clear. The evidence increasingly suggests that this needs to be an individualized decision. We are learning that there is no one-size-fits-all approach to treating menopausal women."
The latest study to weigh in on the benefits of hormone replacement therapy evaluated depression, energy levels, and other quality-of-life variables in a group of postmenopausal women enrolled in the Heart and Estrogen/Progestin Replacement Study (HERS), conducted between 1993 and 1998. Cardiologist Mark A. Hlatky, MD, and colleagues at Stanford University School of Medicine, published their findings Feb. 6 in the Journal of the American Medical Association.
Roughly 2,800 women were randomized to receive either hormone replacement therapy (HRT) or placebo, and menopausal symptoms were recorded prior to beginning treatment. The mean age of study participants was 67. Women reporting hot flashes or flushes had improved mental health and fewer symptoms of depression when they received HRT, compared with women who had similar symptoms but did not receive the therapy. Those without hot-flash symptoms who received hormone therapy actually had greater declines in physical function and energy levels, compared with women given placebos.
"This therapy is probably doing a lot of good in women who are being treated for symptoms like hot flashes," Hlatky tells WebMD. "But we don't really know right now what it is doing in terms of heart disease prevention. We should know more about that in a few years."
Earlier findings from the HERS trial suggest that HRT may actually be dangerous for women with a history of heart disease. Two major, ongoing studies -- one being conducted in the U.S. and the other in Europe -- are expected to help clarify the role of HRT for prevention in women without a history of heart disease.
Rexrode says there has been a common perception among patients and their physicians that HRT keeps women young, despite a lack of scientific evidence backing this up. Although observational research does suggest better outcomes for women on hormone therapy, she says these women may generally have healthier lifestyles. A physician at Boston's Brigham and Women's Hospital, and an instructor at Harvard Medical School, Rexrode co-authored an editorial accompanying the Stanford Study.
"It does appear that (women on HRT) see their health care providers more often, and may exercise a little more, eat a little better, and have lower body mass," she says. "The question is, 'Is it the women or is it the hormones.' I don't think we know the answer to that."