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Do women without hot flashes benefit from hormone replacement therapy?

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The most common symptom of the menopause is hot flashes; however, not all women entering the menopause experience them. According to the American Congress of Obstetrics and Gynecology (ACOG), approximately 75% of menopausal women in the United States experience them. Hormone replacement therapy (HRT) can relieve hot flashes as well as other menopausal symptoms. A new study evaluated the benefits from HRT on quality of life among women who do not suffer from hot flashes. The findings were published on July 1 in the journal Menopause.

The researchers conducted a study that evaluated the impact of hot flashes and various forms of hormone therapy on health-related quality of life as well as sexual well-being in women who had recently become menopausal. The study group comprised 150 healthy women who were interviewed regarding hot flashes and health-related quality of life with the Women’s Health Questionnaire and the McCoy Female Sexuality Questionnaire). They were also asked about menopause-related symptoms, and general health. The women were divided into two groups: those with (72 women) and those without (78 women) hot flashes. All women were prescribed with a six month regime with transdermal estradiol (skin patch; 1 mg/day), oral estradiol (2 mg/day) with or without medroxyprogesterone acetate (5 mg/day), or a placebo.

The investigators found that at the beginning of the study, hot flashes most strongly affected sleep quality, bodily symptoms such as muscle pains, menstrual cycle–resembling complaints, anxiety and fears, decreased memory and concentration, and sexual behavior The different hormone therapy regimens all relieved hot flashes with equal effectiveness; therefore, the different regimens were combined into a single group for further investigation. Among the women with baseline hot flashes, six months of HRT significantly improved the scores for sleep, memory and concentration capacity, as well as anxiety and fears. HRT use was found to have no significant impact on these factors in women without baseline hot flashes.

The researchers concluded that hot flashes contribute differently to various factors that affect health-related quality of life shortly after menopause. Estradiol or an estradiol–medroxyprogesterone acetate combination were equally effective for alleviating hot flashes and improvement in health-related quality of life factors that were related to the elimination of hot flashes. The noted that HRT use does not offer any detectable quality-of-life benefit over placebo in women without disturbing baseline flashes.

Most women who suffer from hot flashes are well aware of the symptoms: a sudden sensation of heat that rushes into the upper body and face. The skin may redden like a blush and a woman may break out in a sweat. A hot flash may last from a few seconds to several minutes or longer. As noted by the study authors, hot flashes can cause lack of sleep by frequently waking a woman from a deep sleep. Lack of sleep may be noted by a woman as the most troublesome of the menopause.

Take home message:

The lack of quality of life benefits from HRT among women without hot flashes is an interesting finding. Further evaluation of this group of women should be done to determine whether they are equally susceptible to other postmenopausal conditions such as osteoporosis or vaginal dryness. Six months of HRT for a woman just entering the menopause is inadequate to determine bone loss.