Hormone Therapy Yields Mixed Results Among Women
Although it helps women with heart disease who have hot flashes, hormone replacement therapy decreases quality of life for those who don’t have the menopausal symptom, according to a study to be published Wednesday in the Journal of the American Medical Assn.
The common perception is that taking hormone replacement therapy, in addition to relieving symptoms of menopause, makes women feel better, more energized and younger.
However, using data from 2,763 women ages 55 to 79 who had heart disease, researchers from Stanford University found that the therapy had mixed effects. The study was conducted from January 1993 to July 1998.
Among the 15.7% of women who had hot flashes when they entered the Heart Estrogen/Progestin Replacement Study, or HERS, hormone therapy appeared to improve mental health, reduce symptoms of depression and had no effect on physical function or energy compared with a similar group on placebos. But among the remaining 84.3% who had no hot flashes, those on hormone therapy showed greater declines in physical function and energy with no change in mental health or symptoms of depression than women on placebos.
The lead researcher, Dr. Mark Hlatky, said he and his colleagues don’t know why women without hot flashes on hormones showed a greater decline in physical function. “We’re very intrigued; that’s the next thing to dissect out,” he said. Hlatky speculated that for women who had no menopausal symptoms, side effects produced by hormone therapy, such as breast tenderness or a resumption of a period, could represent a loss of physical function.
But Dr. Kathryn Rexrode and Dr. JoAnn Manson, both of Brigham and Women’s Hospital in Boston, theorize in an accompanying editorial that loss of physical function “may well have been due to the increased rates of cardiovascular events associated with hormone therapy.” In 1998, HERS was the first major trial to show that hormone replacement therapy appeared to increase the risk of heart attacks and other coronary events among some women who already had heart disease. Previously, hormone therapy had been thought to be heart protective.
The finding from this latest study, like the initial HERS finding, “challenges widely held assumptions,” Rexrode said in an interview. “There’s this very powerful advertising image that it [hormone therapy] is somehow the fountain of youth, while there’s very little data to back it up,” she said. “This study ought to raise big red flags.” Rexrode also pointed out that preliminary data from the Women’s Health Initiative, a continuing federal study looking at healthy women on hormone therapy, also showed an increase in heart problems among a small percentage of those on hormone therapy compared with those on placebo.
For women who have hot flashes or other menopausal symptoms, hormone therapy “has some clear benefit,” Rexrode said. For those who have no symptoms “the decision is a lot more difficult,” she said.
Dr. JoAnn Pinkerton, director of the Midlife Health Center at the University of Virginia in Charlottesville, concurred, adding that for women with heart disease, hormone therapy “does not appear called for, for heart reasons, aside from quality of life issues.”
But she also pointed out that doctors generally use different doses and combinations of estrogen and progestin, as opposed to HERS, which used one medication at one dose. “Lots of times with an individual, it’s possible to improve quality of life by identifying individual negative responses,” Pinkerton said.
And, she said, more research is being done examining lower doses and different combinations of estrogen and progestin that might reduce negative effects and preserve the benefits of hormone therapy.
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Ridgely Ochs is a reporter for Newsday, a Tribune company.
