HRT may offer improved quality of life for older women

Obstetrics & Gynaecology

Post-menopausal women on hormone replacement therapy (HRT) gain significant improvements in quality of life, according to one of the world's longest and largest trials of HRT involving the University of Adelaide.

The latest study by the WISDOM research team (Women's International Study of long Duration Oestrogen after Menopause) involved 2130 post-menopausal women in the UK, Australia and New Zealand, and assessed the impact of combined oestrogen and progestogen hormone therapy on the women's quality of life. The average age of women in this study was 13 years after menopause and most participants did not have menopausal symptoms.

"Our results show that hot flushes, night sweats, sleeplessness and joint pains were less common in women on HRT in this age group. Sexuality was also improved," said Professor Alastair MacLennan, leader of the Australian arm of WISDOM and head of Obstetrics & Gynaecology at the University of Adelaide.

"Overall, quality of life measures improved. Even when women did not have hot flushes and were well past menopause, there was a small but measurable improvement in quality of life and a noted improvement in sleep, sexuality and joint pains. HRT users also had more breast tenderness and discharge compared to those on a placebo," he said.

Professor MacLennan said studies such as those conducted by WISDOM "enable the risks of HRT to be reduced and its benefits maximised when the treatment is individualised to each woman".

"Early start-up side effects can usually be alleviated by adjusting the treatment," he said.

"For most women with significant menopause symptoms the benefits of HRT outweigh the risks.

"The latest analyses of the main long-term randomised control trial of HRT (The Women's Health Initiative) show that breast cancer is not increased by oestrogen-only HRT and is only increased in women using combined oestrogen and progestogen HRT after seven years of use. This increased risk is less than 0.1% per year of use.

"If a woman feels that HRT is needed for quality of life, then doctors can find the safest regimen for her. She can try going off HRT every 4-5 years, and can then make an informed choice about whether she takes and continues HRT."

Dr Beverley Lawton, Head of WISDOM New Zealand, said: "These new data should be added to the risk/benefit equation for HRT. The quality of life benefits of HRT may be greater in women with more severe symptoms near menopause. New research suggests that HRT taken from near menopause avoids the cardiovascular risks seen when HRT is initiated many years after menopause."

The WISDOM research is independent of the pharmaceutical industry and has been funded by UK, Australian and New Zealand government research bodies.

The results of the study have been published on the British Medical Journal website: www.bmj.com

Story by David Ellis