Menopausal symptoms in older women and the effects of treatment with hormone therapy.
OBJECTIVE
In some women, hot flashes and other symptoms attributed to menopause persist for many years after the cessation of menses. The frequency and severity of such symptoms and response to hormone therapy in older women have not been well documented.


METHODS
We used data from the Heart and Estrogen/Progestin Replacement Study, a blinded, clinical trial among 2763 women with documented coronary disease and a uterus who were randomized to receive either conjugated estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg in one tablet or placebo. Participants were queried at baseline and annually regarding menopausal symptoms. Breast symptoms were self-reported, and uterine bleeding was recorded on a daily diary.


RESULTS
Symptoms associated with menopause were relatively common among Heart and Estrogen/Progestin Replacement Study participants, whose average age was 67 years and who averaged 18 years since menopause. At baseline, 16% of women reported frequent hot flashes, 26% vaginal dryness, 10% genital irritation, 55% trouble sleeping, and 53% early awakening. Women assigned to hormone therapy reported less frequent hot flashes, vaginal dryness, and trouble sleeping compared with women assigned to placebo, but more frequent vaginal discharge, genital irritation, uterine bleeding, and breast symptoms. The reporting of breast symptoms among women in the hormone group decreased from 40% at 1 year to 13% by the 4th year. Uterine bleeding was reported by 31% and spotting by an additional 33% of women in the hormone group during the 1st year of treatment; by the 4th year, these proportions had fallen to 11% and 20%, respectively.


CONCLUSIONS
Symptoms typically attributed to menopause are common in elderly women. Postmenopausal hormone therapy reduces hot flashes, trouble sleeping, and vaginal dryness, but at standard doses in elderly women is associated with vaginal discharge, genital irritation, uterine bleeding, and breast symptoms.
Barnabei
Vanessa M
VM
Medical College of Wisconsin, Milwaukee 53226, USA. barnabei@mcw.edu
Grady
Deborah
D
Stovall
Dale W
DW
Cauley
Jane A
JA
Lin
Feng
F
Stuenkel
Cynthia A
CA
Stefanick
Marcia L
ML
Pickar
James H
JH
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000517:prevention & control; D015331:Cohort Studies; D016001:Confidence Intervals; D005069:Evaluation Studies as Topic; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods*; D019584:Hot Flashes / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D008593:Menopause / Q000187:drug effects* / Q000502:physiology*; D008875:Middle Aged; D017060:Patient Satisfaction; D011336:Probability; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D017258:Medroxyprogesterone Acetate