Aug
A new study published on bmj.comargues that for older women, health related quality of lifecan be improved by hormone replacementtherapy (HRT). The authors recommend that HRT guidelines should berevised with this most current evidence taken into consideration.
Earlier studies have shown that HRT has the potential for generalimprovements in quality of life measures - how patients feel orfunction. The therapy has also been successful in reducing the numberand severityof symptoms related to menopause. However, a weakness in these studiesis that the researchers have used general measures rather than moresensitive condition specific ones.
To add to the body of research dealing with health related quality oflife, ProfessorAlastair MacLennan and colleagues study outcomes of participants in theWISDOM trial - a 10-year study beginning in 1999 that focuses onlong-term benefits and risks of HRT in postmenopausal women. The WISDOMtrial sample consisted of 5,692 healthywomen between the ages of 50 and 69 from the UK, Australia, and NewZealand who were randomly assigned to receive either combined HRT(estrogen and progestogen) orplacebo. On average, women were followed-up for about 12 months soresearchers could test clinical outcomes such as cardiovasculardisease, fractures, and breast cancer. In addition, the women provideddetailed information on how HRT impacted their quality of life.
The quality of life measurement was derived from questionnaireresponses targeted towards physical and emotional components of health(depressed mood, memory, and concentration), sleep problems, and sexualfunctioning. Also included was a symptoms questionnaire.
MacLennan and colleagues found that after one year, women in thecombined HRT group saw significant improvements in sexualfunctioning, sleep problems and vasomotor symptoms (hot flushes andsweats) compared to women in the placebo group. More specifically,women in the HRT group reported:
- Fewer hot flushes (9% v 25%),
- Fewer nightsweats (14% v 23%),
- Less aching joints and muscles (57% v 63%),
- Less insomnia(35% v 41%),
- Less vaginal dryness (14% v 19%),
- More breast tenderness (16% v 7%), and
- More vaginal discharge(14% v 5%).
There were no significant differences between other menopausalsymptoms, depression, and overall quality of life between the twogroups.
Although theseresults are similar to the findings of the Women’s HealthInitiative (WHI) - HRT use reduced hot flushes and night sweats,improved sleep, and eased bodilypain, the WISDOM trial was in fact halted early since the WHI foundthat elderly women taking HRT had more heart attacks than non-HRTusers. These leads the researchers to caution that health relatedquality of life should be weighed against the risk of increased cardiacevents, venousthromboembolism and breast cancer that are associated with HRT.
Health related quality of life after combined hormonereplacement therapy: randomised controlled trial
AmandaJ Welton, Madge R Vickers, Joseph Kim, Deborah Ford, Beverley A Lawton,Alastair H MacLennan, Sarah K Meredith, Jeannett Martin, Tom WMeade for the WISDOM team
BMJ (2008). 337: a1190.
doi:10.1136/bmj.a1190
ClickHere to View Journal Web Site
Written by: Peter M Crosta
Copyright: Medical News Today