Short-term menopausal hormone therapy for symptom relief: an updated decision model.
BACKGROUND
Hormone therapy (HT) provides the most effective relief of menopausal symptoms. This therapy is associated with a decreased risk of osteoporosis and colorectal cancer but increased risks of cardiovascular disease (CVD), venous thrombosis, and breast cancer. Our objective was to identify which women should benefit from short-term HT by exploring the trade-off between symptom relief and risks of inducing disease.


METHODS
A Markov model simulates the effect of short-term (2 years) estrogen and progestin HT on life expectancy and quality-adjusted life expectancy (QALE) among 50-year-old menopausal women with intact uteri, using findings from the Women's Health Initiative. Quality-of-life (QOL) utility scores were derived from the literature. We assumed HT-affected QOL only during perimenopause, when it reduced symptoms by 80%.


RESULTS
Among asymptomatic women, short-term HT was associated with net losses in life expectancy and QALE of 1 to 3 months, depending on CVD risk. Women with mild or severe menopausal symptoms gained 3 to 4 months or 7 to 8 months of QALE, respectively. Among women at low risk for CVD, HT extended QALE if menopausal symptoms lowered QOL by as little as 4%. Among women at elevated CVD risk, HT extended QALE only if symptoms lowered QOL by at least 12%.


CONCLUSIONS
Hormone therapy is associated with losses in survival but gains in QALE for women with menopausal symptoms. Women expected to benefit from short-term HT can be identified by the severity of their menopausal symptoms and CVD risk.
Division of General Internal Medicine, Rhode Island Hospital, Brown Medical School, Providence 02903, USA. ncol@lifespan.org
Nananda F
NF
Col
Griffin
G
Weber
Anne
A
Stiggelbout
John
J
Chuo
Ralph
R
D'Agostino
Phaedra
P
Corso
D001741:Black or African American / Q000706:statistics & numerical data; D002979:Climacteric; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D008875:Middle Aged; D009026:Mortality; D009656:North America / Q000453:epidemiology; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012306:Risk