HT for hot flashes didn't improve quality of life.(Gynecology)

BETHESDA, MD. -- Now that results from the Women's Health Initiative have shot down hormone therapy as a way to prevent coronary events, dementia, and urinary incontinence in postmenopausal women, the only indication left standing has been relief of menopausal symptoms, especially vasomotor symptoms such as hot flashes.

But even this application is on shaky ground, thanks again to results from the Women's Health Initiative (WHI).

One problem with using estrogen plus progestin, or estrogen alone to manage vasomotor symptoms is that a comprehensive quality-of-life assessment in the WHI showed no clinically significant benefit from hormone therapy, Jennifer Hays, Ph.D., said at a conference on the Women's Health Initiative, sponsored by the Department of Health and Human Services. This result carries the caveat that the WHI hormone study enrolled only women who were willing to accept randomization to placebo, which means that women with the worst symptoms were probably not included.

A second problem is that 56% of women in the WHI who had hot flashes when they started hormone therapy experienced a recurrence 8-12 months after stopping hormone therapy.

The finding that symptoms recurred after hormone therapy stopped is "very important," said Dr. Hays, a developmental psychologist at Scott & White Hospital in Temple, Tex., and a principal investigator for WHI. "We now talk about treating women with estrogen for a short term, but what happens when women get taken off?"

Despite this drawback, hormone therapy is "clearly still the best treatment for vasomotor symptoms," commented Dr. Robert Brzyski, an ob.gyn, at the University of Texas Health Science Center, San Antonio, and another WHI principal investigator.

The prevalence of menopausal symptoms when women entered the WHI hormone study was related to age. Among women aged 50-54 years, the most common symptom was hot flashes, reported by about 23% of women. Vaginal dryness, headache, and mood swings were each reported by 10%-15% of women, and joint pain was noted by 20%. The prevalence of all symptoms at entry, except joint pain, was lower with increased age. For example, among women aged 55-59 years, the prevalence of hot flashes was 15%.