Effects of Estrogen plus Progestin on Health-Related Quality of Life
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《新英格兰医药杂志》
To the Editor: Hays et al. (May 8 issue)1 conclude that among postmenopausal women enrolled in the Women's Health Initiative (WHI) trial, use of an estrogen–progestin combination did not have a clinically meaningful effect on health-related quality of life, except for a benefit with regard to sleep disturbances among women 50 to 54 years old who had moderate-to-severe vasomotor symptoms. However, the estrogen–progestin combination was associated with significant improvements in the severity of hot flashes and night sweats among women with moderate-to-severe vasomotor symptoms. These findings are clinically relevant and may be used by physicians and menopausal women to guide decisions regarding hormone-replacement therapy. The absence of benefit of hormone-replacement therapy in terms of mental health and depression in the WHI is at variance with the Heart and Estrogen/Progestin Replacement Study,2 which found improvements in emotional measures of health-related quality of life among women with flushing. The fact that women with moderate or severe menopausal symptoms were discouraged from participation in the WHI could have contributed to the absence of significant associations between the use of hormone-replacement therapy and emotional measures of health-related quality of life. Moreover, the instruments used to assess health-related quality of life may not have been sufficiently accurate to capture the effects of vasomotor symptoms on the well-being of postmenopausal women.
Adriana Latado, M.D., M.S.
Gildete B. Lopes, R.N.
Professor Edgard Santos Hospital
Salvador, BA 40110-060, Brazil
References
Hays J, Ockene JK, Brunner RL, et al. Effects of estrogen plus progestin on health-related quality of life. N Engl J Med 2003;348:1839-1854.
Hlatky MA, Boothroyd D, Vittinghoff E, Sharp P, Whooley MA. Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial. JAMA 2002;287:591-597.
To the Editor: There are several reasons why Hays and colleagues failed to show a benefit of postmenopausal hormone therapy on health-related quality of life. As they state, to participate in the WHI hormone study, women already taking hormones had to undergo a three-month washout period, and those with moderate or severe menopausal symptoms were discouraged from participating. Thus, there was a strong selection bias against women who might have experienced a benefit in terms of quality of life. Although the tools used to assess health-related quality of life focused on chronic diseases (the primary end points of the study), they were not the best tools for assessing benefits associated with hormone therapy.
This study shows that relatively healthy, asymptomatic, postmenopausal women do not experience a benefit from postmenopausal hormone therapy in terms of health-related quality of life. However, it is premature to dismiss the benefits for women who have clinically important quality-of-life issues. I am concerned that these results will be extrapolated to all postmenopausal women and that hormone therapy will be denied to women with marked symptoms or not sought or accepted by them. Until appropriate studies are done, clinical judgment should prevail.
Nelson B. Watts, M.D.
University of Cincinnati
Cincinnati, OH 45219(Antonio A. Lopes, M.D., M)
Adriana Latado, M.D., M.S.
Gildete B. Lopes, R.N.
Professor Edgard Santos Hospital
Salvador, BA 40110-060, Brazil
References
Hays J, Ockene JK, Brunner RL, et al. Effects of estrogen plus progestin on health-related quality of life. N Engl J Med 2003;348:1839-1854.
Hlatky MA, Boothroyd D, Vittinghoff E, Sharp P, Whooley MA. Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial. JAMA 2002;287:591-597.
To the Editor: There are several reasons why Hays and colleagues failed to show a benefit of postmenopausal hormone therapy on health-related quality of life. As they state, to participate in the WHI hormone study, women already taking hormones had to undergo a three-month washout period, and those with moderate or severe menopausal symptoms were discouraged from participating. Thus, there was a strong selection bias against women who might have experienced a benefit in terms of quality of life. Although the tools used to assess health-related quality of life focused on chronic diseases (the primary end points of the study), they were not the best tools for assessing benefits associated with hormone therapy.
This study shows that relatively healthy, asymptomatic, postmenopausal women do not experience a benefit from postmenopausal hormone therapy in terms of health-related quality of life. However, it is premature to dismiss the benefits for women who have clinically important quality-of-life issues. I am concerned that these results will be extrapolated to all postmenopausal women and that hormone therapy will be denied to women with marked symptoms or not sought or accepted by them. Until appropriate studies are done, clinical judgment should prevail.
Nelson B. Watts, M.D.
University of Cincinnati
Cincinnati, OH 45219(Antonio A. Lopes, M.D., M)