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Does Estrogen/Progestin Therapy Improve Quality of Life?

Older postmenopausal women without menopausal symptoms showed no improvements in quality of life after 3 years of continuous E/P therapy.

Initially published data from the Women's Health Initiative indicated that postmenopausal women who used continuous combined estrogen/progestin (E/P) therapy experienced significantly greater increases in certain adverse outcomes (i.e., coronary events, stroke, venous thrombosis, and breast cancer) than did placebo recipients (Journal Watch Jul 26 2002). Investigators now have examined the data to determine whether any improvement in quality of life had occurred among E/P users.

A total of 16,608 women (age range, 50-79) with intact uteri were assigned to receive 0.625-mg conjugated equine estrogens plus 2.5-mg medroxyprogesterone acetate or matched placebos daily. Quality-of-life measures (including estimates of general health, vitality, mental health, depressive symptoms, and sexual satisfaction) were collected at baseline and at 1 year for all women and also at 3 years for a subset of 1511 women. At 1 year, users of E/P had a small, but statistically significant, benefit in terms of sleep disturbances, physical functioning, and pain; however, at 3 years, no benefit was noted for any measure. In younger women (age range, 50-54), E/P improved vasomotor symptoms and sleep disturbances at 1 year, but no other benefits were detected.

Comment: An editorialist notes that this analysis provides further evidence for withholding estrogen therapy from all asymptomatic postmenopausal women. These findings suggest that hormone therapy does not improve quality of life among older women without menopausal symptoms, but some of the measurement instruments could have missed small benefits. For some younger symptomatic women, short-term E/P therapy might make the transition to the postmenopausal years tolerable.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine May 9, 2003

Citation(s):

Hays J et al. Effects of estrogen plus progestin on health-related quality of life. N Engl J Med 2003 May 8; 348:1839-54.

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Grady D. Postmenopausal hormones -- Therapy for symptoms only. N Engl J Med 2003 May 8; 348:1835-7.

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