Estrogen Not Effective After Menopause

[Tara]

Estrogen Not Effective After Menopause
By LINDSEY TANNER
Mon Sep 26 2005

Estrogen pills have little effect on older women's quality of life, fresh evidence from a landmark study shows in yet another blow to the myth that most women need the hormones to feel better after menopause.

More than 10,000 women with an average age of 63 were asked about their general health, mental, physical and social functioning, energy level and emotional health before and a year after they started taking either estrogen or dummy pills.

Some scores dipped and others increased slightly, but there was little overall difference between the groups, which each included more than 5,000 women. Women taking estrogen reported slightly fewer sleep problems but slightly worse social functioning than those on dummy pills, but the differences were minimal. Overall quality-of-life scores were high for both groups.

Participants were part of the government's Women's Health Initiative, which did a long-running study on the risks and benefits of hormones.

Use plummeted after results in 2002 linked estrogen-progestin pills sold as Prempro with an increased risk for heart attacks, breast cancer and strokes in postmenopausal women.

Later results showed estrogen-only pills, sold as Premarin, slightly increased older women's risk of a stroke and possibly dementia.

The new results for estrogen-only pills echo previous data from the same study showing estrogen-progestin had little effect on older women's overall well-being and quality of life. The 10,739 women in the latest study, which appeared in Monday's Archives of Internal Medicine, had all had hysterectomies.

In both groups, fewer than 3 percent reported poor quality of life and scores for 40 percent were in the excellent range after a year.

Several doctors said the conclusions cannot be generalized to apply to younger women.

Dr. Julia Johnson, vice chairman of gynecology at the University of Vermont, noted that the women were about 10 years past the age when troublesome symptoms such as hot flashes and night sweats — which can affect quality of life — are most likely to occur.

"Using this study to look at quality of life is sort of like comparing apples and oranges," said Johnson, who was not involved in the study.

Dr. Ginger Constantine of Wyeth Pharmaceuticals, which makes Prempro and Premarin, said hormone pills work for hot flashes and similar problems and that most users take the pills for those symptoms.

University of Nevada researcher Robert Brunner, the study's lead author, said estrogen pills reduced troublesome hot flashes in a subgroup of younger study participants but that these women still didn't report a better quality of life than placebo users.

"Quality of life doesn't only depend on vasomotor symptoms," he said, noting that hormone pills have been linked with unpleasant symptoms including urine leakage that can also affect well-being.

"Yes, it's improving some symptoms, but it's also producing some side effects and that combination ends up resulting in no change" in quality of life, Brunner said.

Dr. Lisa Lau, an obstetrician-gynecologist at Chicago's Rush University Medical Center who was not involved in the study, said it bolsters current thinking "that hormone replacement therapy needs to be individual."

"It's not a vitamin that needs to be added to everybody's regime," she said. "It certainly will not make you feel like you're 20 years old or give you a great sex life."
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Tara