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Hormone Therapy: It's Not for Every Woman

Study says those without hot flashes won't benefit mentally

TUESDAY, Feb. 5, 2002 (HealthDayNews) -- Hormone replacement therapy improves the mental outlook for postmenopausal women who have hot flashes, but a new study says it doesn't help -- and may physically harm -- women who don't have that classic symptom.

"These mixed results suggest hormone therapy does not have a general benefit for postmenopausal women with heart disease; rather, it improves quality of life only when there are symptoms related to menopause," says a report appearing in tomorrow's issue of the Journal of the American Medical Association.

More than a third of American women aged 50 to 74 are taking hormones because estrogen production typically drops after menopause, says the report. The reasons include a belief that hormone replacement therapy (HRT) can help prevent heart disease and the bone-weakening condition, osteoporosis. It is also known to help with less dangerous but still troubling conditions, such as a diminished libido, vaginal dryness, sleeping problems and wild mood swings. However, doubts have been raised about the possible pitfalls of HRT, most notably an increased risk of cancer.

The new study reports on more than 2,700 women, average age 67, who were given either a combination of the hormones estrogen and progestin or a placebo as part of a long-running study.

"We studied quality of life because it is really important to people," Dr. Mark Hlatky, a professor of health policy and research and cardiovascular medicine at Stanford University School of Medicine, says in a statement. "In fact, people are willing to risk shortening their life in order to improve quality of life."

A minority of those women, 434, had hot flashes. The study compared their physical health and mental outlook with that of women who did not have hot flashes.

The women with hot flashes who got HRT had fewer symptoms of depression and improved mental health, compared to those who got the placebo. However, women without hot flashes got no such benefits from HRT, and they experienced greater-than-average declines in physical energy.

In addition, the changes in quality of life due to hormone therapy were overwhelmed by those related to diabetes, high blood pressure, chest pain and heart failure, the study found.

"This study does show improvement of quality-of-life parameters, but the risks need to be weighed against the benefits," says Dr. Kathryn M. Rexrode, an instructor in medicine at Harvard Medical School and co-author of an accompanying editorial.

That editorial says the study "should challenge the widely held belief that hormone therapy helps women remain more youthful, active or vibrant." Rexrode adds "the overall data over the last few years suggest that fewer women than we thought are benefiting from hormone replacement therapy."

One discouraging fact, she says, is "there is very much we don't know about hormone replacement therapy." Some definitive findings should come from the ongoing Women's Health Initiative, which has 25,000 participants in a trial of HRT, Rexrode says, but results are not expected until 2005.

"It's a while to wait, but we have been waiting for a couple of decades," she says.

Meanwhile, the decision about HRT should be made one woman at a time, considering not only hot flashes but also other possibly complicating conditions such as heart disease and diabetes, Rexrode says.

What To Do

"The decision has to be a very individual one, based on a consultation by women with their health-care providers," Rexrode says.

Information about hormone replacement therapy is available from the National Institute on Aging or the University of Maryland.

SOURCES: Interview with Kathryn M. Rexrode, instructor, medicine, Harvard Medical School, Boston; Stanford University School of Medicine news release; Feb. 6, 2002, Journal of the American Medical Association
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