The Pharmaceutical Journal
Vol 270 No 7241 p390
22 March 2003

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Quality-of-life claim made for HRT finally laid to rest

Hormone replacement therapy (HRT) does not result in a better quality of life for older women without menopausal symptoms, an analysis of data from the Women's Health Initiative shows.

WHI researchers, led by Dr Jennifer Hays, of the Baylor College of Medicine, Houston, Texas, point out that, when deciding whether or not to use HRT, women take into account possible improvements in quality of life. However, results from the few trials that have assessed the effect of HRT on health-related quality of life are inconsistent and randomised trials have shown a substantial placebo effect.

The researchers therefore used data from the WHI to investigate the relationship between use of oestrogen plus progestogen and psychosocial measures. They found that women randomised to oestrogen plus progestogen did not report significant improvements in general health, vitality, mental health, depressive symptoms or sexual satisfaction. There was a small benefit in terms of sleep disturbance, physical functioning and bodily pain after one year. However, these benefits were not clinically meaningful.

The researchers point out previous suggestions that positive effects of HRT on health-related quality of life may be masked or delayed during the first year of menopausal symptoms. However, they add: "Our results provide no evidence that long-term use of oestrogen plus [progestogen] has a more positive effect on health-related quality of life than short-term use."

In an accompanying article, Dr Deborah Grady, from the University of California, San Francisco, says that the claim that many women feel better when they use HRT has now been laid to rest. She adds that perimenopausal women who choose to use HRT should start with a low dose and gradually increase it until symptoms are adequately controlled. "An attempt should be made at least every six months to taper the dose of hormones and to discontinue therapy," she suggests.

The study and accompanying editorial are due to be published in the 8 May issue of The New England Medical Journal but are available now as early online articles.

The WHI trial was stopped early when results showed that oestrogen plus progestogen therapy caused small increases in the risks of coronary events, stroke, pulmonary embolism, and breast cancer (PJ, 13 July 2002, p43).