Hormone Therapy Gets Mixed Review

Hormone replacement therapy, used by about two of every five post-menopausal U.S. women, may prolong life but it can also variously help or harm the quality of life in older patients with heart disease, a study said Tuesday.

The finding "should challenge the widely held belief that hormone therapy helps women remain more youthful, active or vibrant" said two experts who assessed the findings.

The study from Stanford University School of Medicine involved nearly 2,800 women with heart disease who were checked on for three years.

The use of estrogen and progestin after menopause "may have either positive or negative effects on quality of life depending on the presence or absence of post-menopausal symptoms," the report said.

The study found that hormones improved mood and reduced symptoms of depression in postmenopausal women who said they had hot flashes before starting on the pills.

However, no significant mental health benefits were found in women without initial hot flashes. These women also reported a more rapid decline in energy and physical activity while on hormones than a placebo group.

Quality of life, a measure of general happiness, was assessed in the study on the basis of energy, physical activity, mental health and symptoms of depression. All of the women in the study had heart disease and their mean age was 67.

Whether similar results would be found in younger women closer to the average age of menopause - 51 - or in women without heart disease is unknown, the researchers said.

"In women with symptoms from menopause, the balance is tipped toward improvement," said Dr. Mark Hlatky, chief author of the report. "In women without symptoms from menopause, the balance is tipped toward lower quality of life. The most likely explanation is that when you don't have any symptoms, it's hard to make you feel better."

In addition, he said, while hormone therapy can reduce menopausal symptoms it can also have side effects such as breast tenderness and abnormal bleeding.

"These mixed results suggest hormone therapy does not have a general benefit for post-menopausal women with heart disease; rather, it improves quality of life only when there are symptoms related to menopause," the study concluded.

An earlier report from the same study published last year found that the therapy does not appear to provide a protective effect against having a heart attack. Hlatky said the jury is still out on whether the treatment prevents heart disease from developing in the first place.

The study, published in this week's Journal of the American Medical Association, said about 38 percent of U.S. women between the ages of 50 and 74 are on hormone replacement therapy.

At menopause the ovaries cease producing estrogen. The impact can be minor or result in such major changes as mood swings, vaginal dryness, lowered libido, hot flashes and insomnia.

The therapy is believed to have the potential to prevent heart disease anward off osteoporosis. There is also a widespread belief, the study said, that hormone replacement may have "general positive effects on the health of older women." Risks associated with the treatment include breast cancer and blood clots, it added.

As a result women are often in a quandary about whether the therapy is right for them, the authors said.

"The net effect of hormone therapy ... may well be to increase life expectancy, yet length of life is not the only consideration for patients making decisions about medical treatments," the study said. "Indeed quality of life may be more important than length of life to many patients."

In an editorial in the same issue commenting on the study, physicians at Brigham and Women's Hospital and the Harvard Medical School in Boston said the findings "should challenge the widely held belief that hormone therapy helps women remain more youthful, active or vibrant."

"Future randomized studies of hormone therapy should include quality of life assessment and provide additional data on this important outcome," the editorial said.

The study's primary contribution "is that the majority of women without (hot flashes) at baseline experienced a decrease in physical function and no improvement in mental health with hormone therapy," the editorial concluded.

Participants in the study were randomly assigned to receive the estrogen-progestin supplement Prempro or a placebo. They answered questionnaires each year asking about mental health, depression, vitality and physical function. Prempro manufacturer Wyeth-Ayerst funded the study.

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