Quality-of-Life and Depressive Symptoms in Postmenopausal Women After Receiving Hormone Therapy: Results From the Heart and Estrogen/Progestin Replacement Study (HERS) Trial

Abstract

Nearly 4 in 10 U.S. women aged 50 to 74 years are taking postmenopausal hormones. Although commonly used to prevent disease, their effects on quality of life remain to be well documented. To this end, the physical and mental effects of hormone replacement therapy (HRT) were assessed in 2763 postmenopausal women known to have coronary artery disease who participated in the Heart and Estrogen/Progestin Replacement Study (HERS). They were randomly assigned to receive either 0.625 mg of conjugated equine estrogen plus 2.5 mg of medroxyprogesterone acetate each day or placebo for 3 years. Physical activity was assessed by the Duke Activity Status Index; energy/fatigue and mental health by the RAND Mental Health Inventory; and depressive symptoms using the Burnam screening scale. A quality-of-life questionnaire evaluated functional capacity, emotional health, vitality, and depression. The treated and placebo groups were similar clinically at baseline; both groups were moderately physically active. Physical function scores declined progressively in both groups. The same was the case for energy/fatigue scores, which revealed a trend toward more rapid decline in women assigned to HRT. Mental health initially was typical of the general population; subsequent changes were small but in the direction of decline. There were no group differences over time in depressive symptoms. Mental health did improve in women with flushing at the outset who took HRT, and they had fewer depressive symptoms than placebo recipients. Conversely, women without flushing who received HRT had a more marked decline in physical function and energy during follow-up. Quality-of-life scores were impaired in older women and those with diabetes, hypertension, chest pain, or heart failure. These effects were much more striking than those of hormone therapy. Postmenopausal women with flushing tend to improve emotionally when given HRT. Those without menopausal symptoms, however, exhibit declining quality of life when given the same treatment.