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Breast Cancer Breast Cancer Treatment Hormone Therapy

Hormone Therapy: Does It Improve Quality of Life?

Medically Reviewed On: May 08, 2003

By Christine Haran

Few women's health studies have created as many shock waves as the Women's Health Initiative (WHI), which found that hormone therapy offered more risks than benefits to postmenopausal women who still had their uteruses. Since those results were published in July 2002, many women have stopped taking hormone therapy. This April, researchers published a study examining hormone therapy's impact on quality of life in WHI participants.

Combination hormone therapy, consisting of estrogen and progestin, has been prescribed for decades to quell the symptoms of menopause, prevent heart disease and osteoporosis, and "slow the aging process," thereby helping women no longer producing estrogen stay healthy and feel youthful. This recommendation was based on patients' accounts of their improved health and studies that observed women who were taking hormones and those were not. It is now known that the lower rates of disease and higher quality of life in the women in these studies who took hormones was more likely due to their better overall health than the effects of the hormones. These women tended to be, for example, thinner and to have better access to healthcare. The WHI was the first clinical trial to follow women who were randomly selected to receive either estrogen alone, or in combination with progestin, or an inactive substance.

Jennifer Hays, PhD, director for the Center for Women's Health at Baylor College of Medicine in Houston, led the study examining health-related quality of life among women in the WHI study. Dr. Hays and her colleagues' results were published in the May 8th issue of The New England Journal of Medicine. To the surprise of many women and doctors, including the researchers themselves, they found that estrogen plus protestin did not have a clinically meaningful effect on health-related quality of life. Below, Dr. Hays discusses these controversial findings.

Why did you decide to examine quality of life in the Women's Health Initiative?
This quality of life study was planned from the beginning of the WHI as part of our effort to understand the effects of long-term hormone use on 16,608 women between the ages of 50 and 79. Except for one part of the study looking at women who had had hysterectomies and were taking estrogen alone, the WHI was terminated early. The overall health risks outweighed the health benefits in the women taking estrogen plus progestin, compared to the women in that group who were on placebo. So the next question was, "How did these women fare in terms of quality of life?" That data had been collected when they went into the study. Data were gathered one year later on everyone and, after three years, on 1,511 of the participants.

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