March 2003

Comments, Suggestions?

Hormone therapy no magic pill

By Anissa Anderson Orr

Jennifer Hays, PhD

Last July, millions of women undergoing menopause stopped taking combination hormone therapy after a major Women’s Health Initiative study linked it to increased risk of breast cancer, heart disease and stroke.

A follow-up study published online March 17, 2003, in the New England Journal of Medicine at www.nejm.com found that combination estrogen and progestin therapy did not improve the quality of life for women who participated in the trial.

“The good news is that women who stopped taking combination hormone therapy because they were worried about the health consequences won’t suffer any long term effects by not taking them,” said Jennifer Hays, PhD, lead author on the study and director of the Center for Women’s Health at Baylor College of Medicine.

So what do these results mean to the average woman taking combination hormone therapy for menopause? Hays put the study in perspective and discussed options for women who want to control the symptoms of menopause.

What does this study tell us?

It tells us that hormone therapy has no measurable benefit for the women who agreed to participate in this study. The study showed that there were no significant effects of hormone therapy on perceived general health, role limitations--either physical or emotional, vitality, social functioning, mental health, depression, cognitive functioning or sexual satisfaction.

What do you mean by “quality of life?”

Quality of life is a measure of how someone perceives their health to affect their physical, emotional and social functioning. To measure this, we asked study participants questions about how they felt, physically and emotionally, how much energy they had and how their health affected aspects of their daily lives. We also asked questions to measures depressive symptoms, cognitive functioning, sleep disturbances, and satisfaction with their sexual functioning.

Why do so many women swear by hormone therapy to improve their hot flashes?

Hormone therapy is effective for improving hot flashes. But improving hot flashes may not translate into a better sense of overall quality of life. Among the younger women in our study who had moderate to severe hot flashes and night sweats, we observed a 77 percent improvement in hot flashes and a 71 percent improvement in night sweats, but no significant changes on any of the measures except a very small improvement in sleep.

Do these results apply to all postmenopausal women?

First, these results do not apply to women taking estrogen only. All the women in this study were assigned to receive estrogen plus progestin or placebo. The estrogen-only arm of the WHI is still continuing, with a planned completion in March 2005. Second, approximately 20 percent of women experience symptoms that prompt them to seek medical treatment. It is unlikely that these women participated in the study, as our participants were willing to receive either hormones or placebo.

What should a woman with menopausal symptoms do?

Our results show that for most women over 50, estrogen and progestin therapy is not going to make a difference in their lives. It won’t make a major difference in how they feel or function. If a woman is taking combination hormones because she thinks she may be missing out on something otherwise, she should stop. The very small benefits for most women do not outweigh the increased risks of breast cancer, heart attack and stroke. This needs to be another piece of information women should use in their decision about hormone use. The results of the Women’s Health Initiative represent the best data available on hormones and women’s health.

What else can women do to improve quality of life after menopause?

We know from other research that exercise and not smoking are two things women can do to reduce their symptoms and improve their quality of life. Exercise is the best thing a woman can do for her overall health and sense of well being. We have no clinical trial data on other formulations or types of hormones.

To reduce hot flashes, we can learn from our mothers and grandmothers. Wear layered clothing. Stay in a cool room. Avoid hot drinks, alcohol, caffeine and spicy foods. For most women, symptoms improve after one year.

So women who stopped taking hormones when the WHI released their initial findings, hang in there. The worst is almost over.

top

© Copyright 2003 Baylor College of Medicine. All Rights Reserved.