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August 22, 2008

HRT After Menopause Reduces Symptoms

THURSDAY, Aug. 21 (HealthDay News) -- Hormone replacement therapy, even when it's started many years after menopause, can reduce some of the quality-of-life problems caused by menopause, such as sleep problems and hot flashes.

Australian researchers report that women who started hormone replacement therapy (HRT) after menopause and took it for an average of one year had significant improvements in sexual functioning, and fewer sleep problems, hot flashes and sweating than did women taking a placebo.

"The greatest benefits and least risk from HRT are seen in the 99 percent of women who commence HRT for symptom relief near menopause. [This] trial studied much older women who started HRT on average 13 to 14 years after menopause when they had fewer symptoms. Even in this group, improved quality of life was seen in many [taking HRT]," said study author Dr. Alastair MacLennan, head of obstetrics and gynecology at the Women's and Children's Hospital at the University of Adelaide in Australia.

Results of the study were published in the Aug. 22 issue of the British Medical Journal.

Hormone replacement therapy has been under major scrutiny since the Women's Health Initiative (WHI) study was stopped in 2002 because of increases in blood clots, heart disease, stroke and breast cancer risk in women initiating HRT long after menopause. MacLennan's study (dubbed the WISDOM study), which began in 1999 and was originally intended to follow women for up to 10 years on HRT, was also stopped after the WHI findings were released due to concerns that the risks of HRT might outweigh the benefits.

Even though the trial was stopped early, MacLennan and his colleagues had one-year follow-up data for 2,130 women between the ages of 50 and 69. The average age in this study was 63.8.

The women had been randomly assigned to receive either a combination hormone replacement therapy or a placebo. At the time of follow-up, 1,043 were on HRT and 1,087 were on placebo.

Women taking HRT had improvements in many quality-of-life symptoms. For example, hot flashes occurred in 30 percent of the women in the HRT group before starting the hormones, but in just 14 percent at the one year follow-up. In comparison, 29 percent of women taking placebo had hot flashes at the start of the study, while 25 percent were still experiencing them at the follow-up. Improvements were also seen in night sweats, insomnia and vaginal dryness.

Women in the HRT group were, however, more likely to report breast tenderness and vaginal discharge.

No significant differences were seen in reports of depression between the two groups.

The study authors wrote that if women are considering taking HRT many years after menopause, they needed to balance the benefits of hormone therapy against the possible risks when started after menopause, which include heart disease, blood clots and an increased risk of breast cancer.

"I think this is an important study, because since WHI, many have lost sight of the significant benefits of hormone therapy," said Dr. Steven R. Goldstein, an obstetrician and gynecologist at New York University Langone Medical Center. "This study reinforces the notion that for women with these symptoms, HRT can improve your quality of life. And, the worse your symptoms, the more they'll improve."

Plus, both MacLennan and Goldstein pointed out that most women would initiate HRT near menopause, when these symptoms tend to be most severe, and at that time, potential risks are much lower, and the benefits are likely greater.

"For relief of symptoms, it's OK to go on HRT, as long as you have none of the absolute contraindications, like a history of deep vein thrombosis," concluded Goldstein.

More information

To read more about hormone replacement therapy, go to the American Academy of Family Physicians.

SOURCES: Alistair MacLennan, M.D., head, discipline of obstetrics and gynecology, School of Pediatrics and Reproductive Health, The Women's and Children's Hospital, The University of Adelaide, Australia; Steven R. Goldstein, obstetrician and gynecologist, New York University Langone Medical Center, and professor, obstetrics and gynecology, New York University School of Medicine, and author, The Estrogen Alternative and Could It Be Perimenopause?, New York City; Aug. 22, 2008, British Medical Journal

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