New evidence published on BMJ.com today shows that hormone replacement therapy (HRT) can improve the health-related quality of life of older women.
HRT guidelines should be reviewed in light of this evidence, say the authors.
Previous research has suggested that HRT can improve general quality of life (the way patients feel or function) and reduce the number and severity of symptoms associated with the menopause, but these studies have used general rather than more sensitive condition specific measures.
Professor Alastair MacLennan and colleagues present the findings on health related quality of life from the WISDOM trial*. The WISDOM trial began in 1999 and aimed to evaluate the long term benefits and risks of HRT in postmenopausal women over 10 years.
All women were monitored for an average of 12 months, and in addition to the main clinical outcomes of cardiovascular disease, fractures and breast cancer, a detailed assessment of the impact of HRT on quality of life was recorded.
Quality of life was measured using a modified version of the women's health questionnaire designed to assess physical and emotional components of health such as depressed mood, memory and concentration, sleep problems and sexual functioning, and a symptoms questionnaire.
After one year, the researchers found significant improvements in sexual functioning, sleep problems and vasomotor symptoms (hot flushes and sweats) in the combined HRT group compared to the placebo group.
Significantly fewer women in the HRT group reported hot flushes, night sweats, aching joints and muscles, insomnia, and vaginal dryness than in the placebo group, but more reported breast tenderness and vaginal discharge.
Other menopausal symptoms, depression, and overall quality of life were not significantly different in the two groups.
These findings may have important benefits for many symptomatic women, claim the authors, but they caution that the health-related quality of life benefits must be weighed against the risk of increased cardiac events, venous thromboembolism and breast cancer.
Do the risks still overshadow these benefits? Your comments: (Terms and conditions apply)
"I suggest that clinicians do not often take into account how the women feel through the menopausal years. We are all worried about litigation which stops some from allowing women the choice. How women feel and cope now is as important to some as what 'might ' happen in later life.
To others this would be too worrying. With evidence and pragmatism, we ought to be helping women make a choice, on an individual basis, and supporting them through this transitional time. For some it can be a very stressful, symptomatic time; why should women not be allowed to take
something that is known to alleviate symptoms, and improve quality of life? Alternatives are mostly not studied. Alcohol, overweight and smoking are known risks also!" - Elizabeth Kiddy, Suffolk
"I make sure that my menopausal ladies are made aware of the additional risk factors, and I aim to taper off HRT as soon as the patient is amenable to giving it a try, but at least 20% are not prepared to risk losing the "feel-good" factor." - Paul Radnan, Salford
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