The Pharmaceutical Journal
Vol 270 No 7249 p672
17 May 2003

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HRT does not improve quality of life

Hormone replacement therapy (HRT) does not improve health-related quality of life, a study shows.

The research comes from further analysis of the Women’s Health Initiative study which examined the effect of combined HRT in 16,608 postmenopausal women. This analysis used quality of life measures in all women at one year, and in a subgroup of 1,511 women at three years.

No significant differences were found in terms of general health, vitality, mental health, depressive symptoms or sexual satisfaction. At one year, a small significant difference was observed in favour of HRT for sleep disturbance, physical functioning and bodily pain. However the researchers comment that “these differences did not represent meaningful effects according to accepted criteria for clinical effectiveness”. After three years, these differences were not significant. They add: “For most women, these small benefits do not outweigh the risks of heart attack, stroke, blood clots and breast cancer associated with combined hormone therapy.”

A subgroup analysis was carried out for women who had moderate to severe vasomotor symptoms (hot flushes and night sweats) at baseline. Of these women, 77 per cent in the HRT group had improvements in the severity of hot flushes compared with 52 per cent in the placebo group. A similar difference was seen for night sweats (71 per cent compared with 53 per cent, respectively). Small improvements in sleep disturbance were also seen in this subgroup (New England Journal of Medicine 2003;348:1839).

Evidence from this and other recent trails is summed up in an accompanying editorial by Dr Deborah Grady, University of California, San Francisco.

“Postmenopausal therapy with oestrogen and progestogen results in increased risks of disease, does not make asymptomatic women feel better and does not improve cognition. There is no role for hormone therapy in the treatment of women without menopausal symptoms. Women with vasomotor symptoms must weigh the risks associated with treatment against the benefit of symptom relief.” However, she adds that new treatments for vasomotor symptoms that are effective and safe are needed (ibid, p1835).