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Abstract and Introduction
Abstract
Objective. We assessed the impact of hot flashes and various forms of hormone therapy on health-related quality of life and sexual well-being in recently postmenopausal women.
Methods. We prospectively interviewed 150 healthy women about hot flashes and health-related quality of life (using the Women's Health Questionnaire and the McCoy Female Sexuality Questionnaire), menopause-related symptoms, and general health. The women were classified into those with (n = 72) and without (n = 78) hot flashes and treated for 6 months with transdermal estradiol (1 mg/d), oral estradiol (2 mg/d) with or without medroxyprogesterone acetate (5 mg/d), or placebo.
Results. At baseline, hot flashes contributed most strongly to poor sleep (correlation coefficient r = −0.525, P < 0.0001), somatic symptoms such as muscle pains (r = −0.348, P < 0.0001), menstrual cycle–resembling complaints (r = −0.304, P < 0.0001), anxiety and fears (r = −0.283, P < 0.0001), decreased memory and concentration (r = −0.279, P = 0.001),and sexual behavior (r = −0.174, P = 0.035). The different hormone therapy regimens alleviated hot flashes equally effectively and were therefore combined into a single group for further analysis. In women with baseline flashes, hormone therapy use significantly improved the scores for sleep (0.787 [0.243] vs 0.557 [0.249], hormone therapy vs placebo, P = 0.001, at 6 mo), memory and concentration capacity (0.849 [0.228] vs 0.454 [0.301], P < 0.0001, at 6 mo), and anxiety and fears (0.942 [0.133] vs 0.826 [0.193], P = 0.005, at 6 mo). Hormone therapy use showed no significant impact on these variables in women without baseline flashes.
Conclusions. Hot flashes contribute differently to various variables affecting health-related quality of life shortly after menopause. Estradiol or an estradiol‐medroxyprogesterone acetate combination similarly alleviates hot flashes and improves health-related quality of life in relation to elimination of hot flashes. Hormone therapy use does not confer any detectable quality-of-life benefit over placebo in women without disturbing baseline flashes.
Introduction
Fifty percent to 80% of women complain about menopausal symptoms such as hot flashes, night sweats, sleep disturbances, tiredness, and depressive mood. They are the principal determinants of a reduced health-related quality of life (HRQL), which is detectable quite soon after the onset of menopause. It is a common belief that hot flashes (originating from hypothalamic dysregulation of thermal centers as a consequence of reduced estrogen levels) would be the primary sign of menopause, and that other mental or somatic symptoms would only be secondary phenomena to hot flashes. However, in view of the profound effects of estrogen on, for example, neural cells and connective tissues, the secondary characters of many nonflash symptoms can be questioned.
The delineation between flashes and nonflash symptoms in clinical research is difficult. First, severe hot flashes, with or without night sweats, are often so dominant that they override the other symptoms. Second, women show marked differences in their capacity to tolerate hot flashes; some are disturbed by flashes that are readily acceptable by others. A woman may not be totally unbiased while judging her hot flashes; undue negative coverage of hormone therapy (HT) by the media has influenced some women to "tolerate" even rather severe symptoms to avoid the initiation of HT. Third, hot flashes show marked day-to-day or even hour-to-hour variations; therefore, their reliable assessment is prone to large interindividual and intraindividual fluctuations. Preferably, hot flashes should be assessed prospectively with interview tools, which aim to be maximally objective; this was not the case in many previous quality-of-life trials. Generally, only women with intolerable hot flashes are considered as candidates for HT.
Oral or transdermal estrogen is a drug of choice for hot flashes and other menopausal symptoms. Estrogen-only therapy is applicable for hysterectomized women, whereas nonhysterectomized women must combine estrogen with a progestin for endometrial protection. Progestin may, however, oppose or even eliminate the positive effects of estrogen. In this regard, medroxyprogesterone acetate (MPA), which was combined with conjugated equine estrogens in the Women's Health Initiative trial, has been most discussed because MPA may worsen cognitive function. The effect of different hormonal regimens on HRQL is poorly understood.
We analyzed the impact of hot flashes on HRQL, general health, and sexual well-being within the first 6 to 36 months after menopause. The women were classified into those with or without hot flashes and treated with transdermal or oral HT, with or without MPA, in a randomized placebo-controlled trial for 6 months to see how the treatments affect life quality variables in these women.
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