title: The impact of hormone therapy on health-related quality of life: longitudinal results from the Study of Women's Health Across the Nation.
abstract: OBJECTIVE
  To determine the impact of hormone therapy (HT) on health-related quality of life (HRQOL) during the menopausal transition and to examine variation based on menopausal symptom status.
  
  
  METHODS
  The Study of Women's Health Across the Nation is a multisite, multiethnic study of mid-life women without baseline HT use. Women completed annual questionnaires including HT use, menstrual bleeding, symptoms, and HRQOL (Medical Outcomes Study Short Form-36). We compared baseline characteristics of women who initiated HT during follow-up with noninitiators. We examined the effect of HRQOL on the likelihood of initiating HT using survival analysis and the relationship between HT initiation and subsequent HRQOL using longitudinal random effects models. Among HT initiators, we compared change in HRQOL between women with frequent (>or=6 d/wk) and infrequent symptoms.
  
  
  RESULTS
  Of the 3,102 participants, 813 initiated HT during the 6-year follow-up period. At baseline, women who subsequently initiated HT were more likely to report poor role physical functioning, higher socioeconomic status, and frequent symptoms and to be white. In longitudinal analyses, women reporting poor role emotional and physical functioning at the visit before initiation were less likely to subsequently initiate (hazard ratio [95% CI]: 0.76 [0.62-0.91] and 0.58 [0.47-0.71]; P<0.01 and <0.0001, respectively), and initiation was associated with subsequent poorer role physical functioning (odds ratio [95% CI]: 1.26 [1.02-1.56]; P=0.03). Among HT initiators, frequent symptom reporters showed improvements in vitality (+2.7) compared with other initiators (-2.9) (P<0.01).
  
  
  CONCLUSIONS
  Poor HRQOL does not increase the likelihood of initiating HT, nor is HT use associated with HRQOL improvements. The exception is women reporting frequent symptoms who report improved vitality after initiation. Future studies may employ more frequent HRQOL measures to further discern this trend.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. hessr@upmc.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: Hess
authors.forename: Alicia
authors.initials: A
authors.lastname: Colvin
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Avis
authors.forename: Joyce T
authors.initials: JT
authors.lastname: Bromberger
authors.forename: Miriam
authors.initials: M
authors.lastname: Schocken
authors.forename: Janet M
authors.initials: JM
authors.lastname: Johnston
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
mesh_terms: D003657:Decision Making; D015914:Estrogen Replacement Therapy / Q000523:psychology*; D005006:Ethnicity; D005260:Female; D006306:Health Surveys; D019584:Hot Flashes; D006801:Humans; D008593:Menopause / Q000187:drug effects / Q000502:physiology* / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D011788:Quality of Life / Q000523:psychology*; D015983:Selection Bias; D012720:Severity of Illness Index; D020919:Sleep Disorders, Intrinsic; D014623:Vaginal Diseases; D044465:White People; D016387:Women's Health