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By Susan Okie
In older women, taking the
sex hormones estrogen and progestin does not improve emotional well-being
except among those suffering from hot flashes, a new study suggests. In
women without hot flashes, the hormones may actually worsen physical functioning.
The researchers called the
results surprising and said they cast doubt on the popular belief, encouraged
by drug advertisements, that taking hormones after menopause can make
most women feel more youthful, active and vibrant.
"These findings are challenging
that perception," said JoAnn E. Manson, chief of preventive medicine
at Harvard's Brigham and Women Hospital. "This study would suggest
that perhaps we should remove quality-of-life benefits from the risk/benefit
equation" when women are considering whether to take hormones after
menopause.
Thirty-eight percent of
U.S. women between the ages of 50 and 74 take hormones after menopause,
according to a national
survey published in 1999. However, the new findings are the latest in
an array of studies that have raised questions about whether such treatment
confers a net health benefit.
For example, estrogen increases
the risk of blood clots, gall bladder disease, uterine cancer and breast
cancer.
Manson and other experts emphasized
that the new study confirmed that women suffering from frequent hot flashes
do obtain relief from hormone treatment. Hot flashes - sudden episodes
of skin flushing, sweating and a sensation of uncomfortable warmth - occur
in 70 percent of women during menopause and are sometimes severe enough
to cause insomnia, fatigue and irritability.
In some women they abate after
a year or two, while in others they continue for a decade or more. Among
study participants with hot flashes, hormone treatment improved symptoms
of depression and did not reduce physical well-being.
The new study, led by cardiologist
Mark A. Hlatky of Stanford University, examined physical functioning,
energy levels, mental health and depressive symptoms among 2,763 women
who participated in the HERS trial, a research project originally designed
to find out whether women with heart disease would benefit from treatment
with estrogen and progestin.
Women in the study were randomly
allocated to receive either hormone treatment or a placebo. Researchers
then followed their health for three years.
In the group as a whole, physical
functioning, energy and mental health declined during the study, perhaps
reflecting their underlying heart disease. However, at the start of the
study, 16 percent of the women said they were bothered by hot flashes,
and their baseline indicators of physical and mental health were worse
than for the other participants.
Among this group, hormone treatment
improved depression and mental health without significantly affecting
energy levels or physical functioning.
In contrast, women without
hot flashes who received hormone treatment showed a faster decline in
physical functioning than women given a placebo, but no significant difference
in mental health or symptoms of depression.
Washington
Post February 5, 2002
JAMA February 6, 2002:287:591-97
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