Women's/Children's Health

Quality-of-life benefits of short-term hormone therapy may outweigh the risks for some menopausal women

Hormone replacement therapy (HRT) is the most effective treatment for menopausal symptoms, and its use is associated with a decrease in the risk of osteoporosis and colorectal cancer, according to findings from the Women's Health Initiative (WHI). The WHI trial also showed that combined estrogen and progestin HRT increases the risk of coronary heart disease (CHD), stroke, pulmonary embolism (PE), and breast cancer. Nevertheless, when quality of life is taken into account, the benefit of short-term (up to 2 years) HRT may outweigh the risks for some women, according to a recent study supported by the Agency for Healthcare Research and Quality (HS13329).

Whether short-term HRT is considered beneficial depends primarily on a woman's treatment goals, the severity of her estrogen-responsive symptoms, and her cardiovascular disease (CVD) risk, says Brown Medical School researcher, Nananda F. Col, M.D., M.P.P., M.P.H. Dr. Col and her colleagues explored the trade-off between short-term symptomatic relief and risks of chronic disease to determine which women might benefit from short-term HRT. They developed a model to simulate the impact of combination estrogen and progestin HRT for 2 years among a healthy group of 50-year-old white menopausal women with intact uteri. The model simulated the impact of short-term HRT (vs. no HRT) on estrogen deficiency symptoms (assuming an 80 percent improvement in symptoms), life expectancy, quality-adjusted life expectancy (QALE), and clinical end points affected by HRT, such as stroke and breast cancer, based on WHI data.

Women with mild menopausal symptoms gained 4.3 months QALE from HRT if they were at low CVD risk and 3.3 months if they were at high CVD risk. Those with severe symptoms gained 8.3 or 6.9 months, respectively. In contrast, asymptomatic women who used HRT experienced net losses in QALE of 25 days to 2.9 months, depending on CVD risk. Individual risk levels of osteoporosis, breast cancer, and colorectal cancer had little effect on these analyses, reflecting their low prevalence among the women examined, the small relative risk of HRT on these outcomes, and the short duration of HRT.

Details are in "Short-term menopausal hormone therapy for symptom relief," by Dr. Col, Griffin Weber, M.D., Ph.D., Anne Stiggelbout, Ph.D., and others, in the August 2004 Archives of Internal Medicine 164, pp. 1634-1640.

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