An article and related commentary on the risks and quality-of-life issues of hormone replacement therapy, scheduled to appear in the May 8, 2003 issue of the New England Journal of Medicine, have been released early by the journal because of their potential therapeutic implications.
The article, prepared by researchers conducting the Women's Health Initiative, a large, randomized trial of combined estrogen and progestin therapy in ethnically and geographically diverse postmenopausal women, noted that some small benefit was seen in terms of sleep disturbances, physical functioning, and pain. There were no significant benefits on a wide range of other quality of life measures, leading to the conclusion that "for most women, these small benefits do not outweigh the risks of heart attack, stroke, blood clots, and breast cancer associated with combined hormone therapy."
In the journal's "Perspective" column, Deborah Grady, M.D., M.P.H., suggests that relatively younger women experiencing disabling menopausal symptoms might benefit from hormone replacement therapy. Risks, although lower, still exist and should be weighed in decision-making. For postmenopausal women who do not have menopausal symptoms, however, "there is no role for hormone therapy."
Available to provide additional perspective on hormone replacement therapy (HRT) and quality-of-life issues are C. Noel Bairey Merz, M.D., and Steven S. Khan, M.D. Both are board-certified cardiologists who are involved in a four-center study, the Women's Ischemia Syndrome Evaluation (WISE), sponsored by the National Heart, Lung and Blood Institute. Dr. Bairey Merz is primary investigator of this large-scale study on women and heart disease, which includes women of various ages who undergo diagnostic angiography after complaining of chest pain. A number of related studies and articles have developed from observations and findings.
Dr. Bairey Merz and colleagues are currently completing a study assessing HRT and psychological health in women, particularly examining differences related to ethnicity. White women are more likely than black women to use HRT, according to previous observational studies, and little has been known about psychological effects of HRT on the black women who use it.
Dr. Bairey Merz directs Cedars-Sinai's Women's Health Program and the Preventive and Rehabilitative Cardiac Center. She holds Cedars-Sinai's Women's Guild Chair in Women's Health and serves as national spokesperson for the Women's HeartAdvantage campaign, a nationwide program designed to help women learn more about the symptoms and treatment of heart disease and heart attacks.
Dr. Khan is director of the Heart Failure Program and director of Clinical Trials in the Division of Cardiology at Cedars-Sinai
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