Health Related Quality of Life After Combined Hormone Replacement Therapy: Randomised Controlled Trial
Welton AJ, Vickers MR, Kim J, et al; WISDOM team.
BMJ 2008;337:a119018719013.
Postmenopausal Hormone Use and Symptoms of Gastroesophageal Reflux
Jacobson BC, Moy B, Colditz GA, Fuchs CS.
Arch Intern Med 2008;168:1798–1804..
Women take hormone replacement therapy (HRT) to improve their quality of life. Symptoms such as hot flashes, sleep difficulties, vaginal dryness, unsatisfactory sexual function, and emotional disturbances are the main indications for commencing HRT. These symptoms will remain the reasons for prescribing HRT despite the Women’s Health Initiative (WHI) trial casting doubt on the benefits for women starting treatment 10 to 15 years after menopause.
A study reported by Welton and colleagues that paralleled the WHI trial was the Women’s International Study of Long Duration Oestrogen after the Menopause (WISDOM) investigation. It was scuppered by the WHI results, but there were sufficient data on quality-of-life outcomes over 1 year in women taking combined HRT or placebo. The domains in which the replacement therapy proved significantly better were vasomotor symptoms, sexual functioning, sleep problems, night sweats, vaginal dryness, and aching joints or muscles. On the downside, more women complained of breast tenderness and vaginal discharge.
The participants in the WISDOM trial initiated treatment a considerable time after menopause, but the fact that they derived benefit restores some faith in the role of HRT in its primary function-symptomatic relief of hypoestrogenic effects. There was no discernable influence on depression or other climacteric symptoms over the short term. The possible protective effects of HRT commenced soon after menopause on cognitive function, protection from Alzheimer disease, and cardiovascular effects are still unknown.
Another feature of HRT may be its effect on gastroesophageal reflux. Jacobson and coworkers reported on a large observational study in which women using estrogen were more at risk of experiencing heartburn than nonusers. The odds ratio was 1.66, and those taking combined HRT had only slightly less risk. The investigators found that the larger the dose and the longer the duration of use, the greater the likelihood of symptoms. The absolute risk is that approximately 1 in 4 women will report such effects, and taking estrogen increases a woman’s chance of being in the symptomatic category.