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New Study Shows Improved Quality of Life for Older Women on HRT E-mail
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New evidence published on BMJ.com shows that hormone replacement therapy (HRT) can improve the health related quality of life of older women. Previous research has suggested that HRT can improve general quality of life (the way patients feel or function) and reduce the number and severity of symptoms associated with the menopause, but these studies have used general rather than more sensitive condition specific measures.

The WISDOM Trial HRT Study

Professor Alastair MacLennan and colleagues present the findings on health related quality of life from the WISDOM trial*. The WISDOM trial began in 1999 and aimed to evaluate the long term benefits and risks of HRT in postmenopausal women over 10 years. It randomised 5,692 healthy women aged 50–69 from general practices in the UK, Australia and New Zealand to receive either combined HRT (oestrogen and progestogen) or placebo.

All women were monitored for an average of 12 months, and in addition to the main clinical outcomes of cardiovascular disease, fractures and breast cancer, a detailed assessment of the impact of HRT on quality of life was recorded.

Quality of life was measured using a modified version of the women’s health questionnaire designed to assess physical and emotional components of health such as depressed mood, memory and concentration, sleep problems and sexual functioning, and a symptoms questionnaire.

After one year, the researchers found significant improvements in sexual functioning, sleep problems and vasomotor symptoms (hot flushes and sweats) in the combined HRT group compared to the placebo group.

Significantly fewer women in the HRT group reported hot flushes (9% v 25%), night sweats (14% v 23%), aching joints and muscles (57% v 63%), insomnia (35% v 41%), and vaginal dryness (14% v 19%) than in the placebo group, but more reported breast tenderness (16% v 7%) and vaginal discharge (14% v 5%).

Other menopausal symptoms, depression, and overall quality of life were not significantly different in the two groups.

These results are consistent with the findings of the Women’s Health Initiative and support the conclusion that after one year, women who started taking combined HRT many years after the menopause, experienced reduced hot flushes and night sweats, improved sleep, and less bodily pain, say the authors.

These findings may have important benefits for many symptomatic women, claim the authors, but they caution that the health related quality of life benefits must be weighed against the risk of increased cardiac events, venous thromboembolism and breast cancer.

Note: The WISDOM trial was halted early when another trial, the Women’s Health Initiative (WHI), which also initiated HRT on average 13 years after menopause, found that elderly women taking HRT had more heart attacks than non-HRT users. This was not seen when HRT was initiated near menopause, which is the common time of use.

About Hormone Replacement Therapy

Hormone replacement therapy (HRT) now often referred to as "treatment" rather than therapy, is a system of medical treatment for surgically menopausal, perimenopausal and to a lesser extent postmenopausal women, based on the assumption that the treatment may prevent discomfort caused by diminished circulating estrogen and progesterone hormones. Hormone replacement therapy (HRT) involves the use of one or more of a group of medications designed to artificially boost hormone levels. The main types of hormones involved in hormone replacement therapy (HRT)are estrogens, progesterone or progestins, and sometimes testosterone.

HRT is available in various forms. It generally provides low dosages of one or more estrogens, and often also provides either progesterone or a chemical analogue, called a progestin. Testosterone may also be included. In women who have had a hysterectomy, an estrogen compound is usually given without any progesterone, a therapy referred to as "unopposed estrogen therapy". HRT may be delivered to the body via patches, tablets, creams, troches, IUDs, vaginal rings, gels or, more rarely, by injection. Dosage is often varied cyclically, with estrogens taken daily and progesterone or progestins taken for about two weeks every month or two; a method called "sequentially combined HRT" or scHRT. An alternate method, a constant dosage with both types of hormones taken daily, is called "continuous combined HRT" or ccHRT, and is a more recent innovation. Sometimes an androgen, generally testosterone, is added to treat reduced sexual desire/(libido). It may also treat reduced energy and help reduce osteoporosis after menopause.

HRT is seen as a short-term relief (often one or two years, usually less than five) from menopausal symptoms (hot flashes, irregular menstruation, fat redistribution etc.). Younger women with premature ovarian failure or surgical menopause may use hormone replacement therapy for many years, until the age that natural menopause would be expected to occur.

Hormone replacement therapy (HRT) has been out of favor by many doctors in recent years because of findings announced in 2002 by the Women's Health Initiative (WHI) of the National Institutes of Health that the treatment (Prempro) they were using in the main part of their study coincided with a larger incidence of breast cancer, heart attacks and strokes. The WHI studies were the first large, double-blind, placebo-controlled clinical trials of HRT in healthy, postmenopausal women. The conclusion of the study was that the HRT combination presented risks that outweighed its measured benefits. The results were almost universally reported as risks and problems associated with HRT in general, rather than with the specific proprietary combination of conjugated equine estrogen and progestin studied.

The WHI findings were reconfirmed in a following wide-scale, national study done in the UK, known as the Million Women Study. As a result of these findings, the number of women taking hormone treatment has dropped by almost half. The warning that followed the announcements, in the Journal of the American Medical Association and elsewhere, is that women with normal rather than surgical menopause should take any prescribed HRT treatment at the lowest feasible dose, for the shortest possible time. For health problems associated with menopause such as osteoporosis (a small percentage of postmenopausal women are at risk of severe bone loss), other life-style changes and/or medications are now recommended.

 
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