HRT Well After Menopause Can Still Make a Difference in Quality of Life

Adding to the speculation about the benefit of estrogen therapy, a study published in the British Medical Journal this week tells us that even when started well after menopause, combined hormone therapy can improve the quality of life for women with certain symptoms. The most improvement was in hot flashes, sleep quality and sexual function. Women also noticed less body pain after starting the hormones.

This is not exactly news for women who have found relief with hormone therapy. I know women who would break the arm of any doctor who tried to talk them out of using estrogen. I also know women who stopped taking it immediately when the Women's Health Initiative study showed an increased risk of stroke and breast cancer for women taking combined hormone therapy. The question has never been, "Does it help?" but rather, "Is it worth the risk?"

This new study out of Australia is yet another piece of the puzzle, and probably will not change any of the current recommendations. What it does underline is the need to consider each woman individually and plan treatment based on her unique set of symptoms and risk factors. If hot flashes, insomnia and vaginal dryness are making her life miserable, and if she is not at particular risk for a blood clot or breast cancer, hormone therapy may be worth a try.

Some of the side effects suffered by women in the Australian study, such as breast tenderness and vaginal discharge, are common with estrogen therapy. Since the dose used in the study was on the high side, and was not adjusted for each participant, it is possible that side effects could be minimized by adjusting the dose and type of hormone therapy depending on each woman's response.

The study also makes it obvious that we need good research on various dosages, various ages, and various types of hormone therapy. It would be nice to know about low dose therapy for women at each stage of the menopause transition. And what are the risks of the patch as compared to oral estrogens? Are bioidenticals as risky as conjugated estrogens? I'd like to see a dollar of research funding for every hot flash suffered. Now there's a proposal for the NIH.