Short-term hormone therapy: Risks and benefits

08/05/04

CHICAGO A computer-based simulation model suggests that short-term hormone therapy (HT) is associated with increases in quality of life for women with menopausal symptoms, but may shorten life expectancy, according to an article in the August 9/23 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, decisions concerning menopausal hormone therapy (HT) are difficult due to the complexity of balancing the risks and benefits of this treatment. HT is an effective treatment for menopausal symptoms and decreases the risks of osteoporosis and colorectal cancer, but it may also increase the risk of coronary heart disease, stroke, blood clots and breast cancer.

Nananda F. Col, M.D., M.P.P., M.P.H., of Rhode Island Hospital, Providence, and colleagues investigated which women would benefit from short-term HT by weighing symptom relief against risks of causing disease.

The researchers developed a Web-based computer model to simulate the effects of short-term HT use (two years) on life expectancy and quality-adjusted life expectancy (QALE, a measurement of the number of high quality of life years that can be expected over the course of a lifetime) among 50-year-old menopausal women (without hysterectomy). The researchers based their model on findings from the Women's Health Initiative, which reported on some of the risks associated with HT.

The researchers found that among women without any symptoms of menopause, short-term HT was associated with overall losses in life expectancy and QALE of one to three months, depending on their risk of cardiovascular disease. Women with mild to severe menopausal symptoms gained three to four months or seven to eight months of QALE, respectively.

"Whether short-term HT is beneficial or harmful depends primarily on a woman's treatment goals, the severity of her estrogen-responsive symptoms, and her CVD risk," the authors write. "If the goal is to maximize longevity, HT is not advisable, since it is associated with small losses in life expectancy. However, if the goal is to maximize QALE, HT can be beneficial, especially among women at low CVD risk, among whom HT is associated with gains in QALE even when menopausal symptoms are mild," write the researchers.

The authors conclude: "Hormone therapy is associated with losses in survival but gains in QALE for women with menopausal symptoms. Women expected to benefit from short-term HT can be identified by the severity of their menopausal symptoms and CVD risk."

(Arch Intern Med. 2004;164:1634-1640. Available post-embargo at http://www.archinternmed.com). Editor's Note: This work was supported in part by a grant from the Agency for Healthcare Research and Quality, Rockville, Md.; the American Cancer Society Breast Cancer Prevention Forum, Atlanta, Ga.; and a Generalist Physician Faculty Scholars Award from the Robert Wood Johnson Foundation, Princeton, N.J.

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