By Karla Gale
NEW YORK (Reuters Health) – For older postmenopausal women, hormone replacement therapy (HRT) appears to be of benefit only in those women who are still experiencing menopausal symptoms, based on results of a study appearing in The Journal of the American Medical Association for February 6.
According to members of the Heart and Estrogen/Progestin Replacement Study (HERS) Research Group, women without symptoms related to postmenopause actually experience greater declines in physical function when treated with HRT.
The study involved 2763 postmenopausal women, mean age 67, with a history of CAD who were randomly assigned to daily treatment with conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg or placebo. The participants completed a series of questionnaires at baseline and after 3 years of followup.
"This is the largest study of its kind in postmenopausal women, and the only major one dealing mostly with prevention," author Dr. Mark A. Hlatky, of Stanford University School of Medicine in California, told Reuters Health.
The HERS investigators found that "the effect of a therapy on quality of life depends on whether someone has symptoms that are likely to improve with treatment," Dr. Hlatky said. "In our study, women with menopausal symptoms had generally better quality-of-life. In contrast, women without symptoms had generally worse quality of life. While these effects were not dramatic, they were definitely present."
Specifically, for women who reported flushing at entry, those on HRT had improved mental health scores (+2.6, p – 0.04) and fewer depressive symptoms (-0.5 vs + 0.007, p = 0.01) compared with those receiving placebo treatment. The women without baseline flushing who were assigned to HRT had greater declines in physical function (-4.2 vs -3.3, p = 0.04) and in energy/fatigue (-4.6 vs -3.1, p = 0.03) than those on placebo.
Based on previous findings of the HERS study, Drs. Kathryn M. Rexrode and JoAnn E. Manson, of Harvard Medical School in Boston, reiterate that HRT should not be used if its purpose is to prevent cardiovascular disease. Rather, decisions regarding its use should be based on noncoronary benefits and risks.
"The study by Hlatky et al…only strengthens the clinical recommendations that hormone therapy should be avoided or considered only as a secondary option among women with coronary heart disease[??abbreviate??]," the editorialists conclude.