Brand new research published today in the British Medical Journal(1) shows the results of one of the world’s longest and largest trials of hormone replacement therapy (HRT).
This latest study by the WISDOM research team (Women’s International Study of long Duration Oestrogen after Menopause) involved 2,130 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 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.
We asked two New Zealand experts to comment of the findings of this study.
Dr Stella Milsom is a Reproductive Endocrinologist with Fertility Associates and the Department of Reproductive Medicine, National Women’s Hospital. She comments:
“Most menopausal physicians believe that symptoms related to menopause – vasomotor symptoms, sleep disturbance, mood change and vaginal dryness – significantly affect quality of life. However, trials which specifically measure general quality of life in menopause using generic and disease specific questionnaires are only now emerging from the menopause literature.
This new publication from the WISDOM investigators reports on quality of life in 2,130 essentially healthy older women with an intact uterus treated with combined oestrogen and progesterone for about one year. Results show small improvements in joint pain (a common menopausal symptom), sleep, and sexual functioning in the women taking HRT. These results also confirmed that HRT significantly decreases vasomotor symptoms and vaginal dryness. There appeared to be no significant benefit of HRT to improve low mood or depression. The lack of benefit on mood in older menopausal women is an important finding as depressive symptoms are often attributed to menopausal status. With current data failing to demonstrate significant improvement in mood older menopausal women should look to proven therapies in treating depression.
The HRT treated women experienced more vaginal bleeding and breast tenderness and over 25% of women discontinued treatment because of these symptoms.
The WISDOM study was discontinued early, so conclusions are not able to be drawn with regard to the sustainability of these small benefits in quality of life and whether longer term risks would be similar to those seen in the Women’s Health Initiative (WHI) study(2). Individual women will need to factor in this additional data on quality of life in terms of their current symptoms of menopause and known risks of HRT treatment. This study does not unfortunately help the decision making of younger more symptomatic women who are considering HRT but does consolidate the WHI study conclusions that HRT is not a risk free solution for all the health issues of menopause.”
Dr.Helen Roberts is a Senior Lecturer in women’s health at the Department of Obstetrics and Gynaecology, University of Auckland. She comments,
“This recent paper gives further results from 2,130 women in the WISDOM study using either HRT or placebo. Recruitment to this study was stopped early by the UK Medical Research Council after the publication of the Women’s Health Initiative (WHI) study. WISDOM originally hoped to recruit 22,300 women.
Previous studies have shown that HRT is helpful for the relief of hot flushes and night sweats and this can often improve sleep. The WISDOM study has found the same. The findings also included overall improvement in quality of life at one year and improvement in joint pains and dry vagina. The authors point out that these differences between women taking HRT and those taking placebo, for most of the health related quality of life measures, were small and may not be clinical significant to the woman.
The major quality of life improvement with HRT is for those women who have hot flushes and night sweats and who use HRT to relieve these symptoms. Thankfully for most women these symptoms only last for a few years which has led to the advice for short-term use. Some women may have vaginal dryness and this can be a long term problem. However local vaginal oestrogen cream provides benefit without the above risks as there is little systemic absorption.”
1. Welton, A. et al. Health related quality of life after combined hormone replacement therapy: randomised controlled trial. BMJ 2008;337:a1190
2. Writing Group for the Women’s Health Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. Principal Results From the Women’s Health Initiative Randomized Controlled Trial. JAMA, 2002; 288 (3): 321-333.
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