While several reports in the last few years have linked hormone replacement therapy with adverse effects, such as an increased risk of heart disease and breast cancer, new research suggests that for certain women the benefits of short-term hormone therapy may outweigh the risks.

Treatment with estrogen and progestin hormones for 2 years provides no benefits for women without menopausal symptoms, and slightly reduces their life expectancy, according to the report in the Archives of Internal Medicine. In contrast, women with menopausal symptoms may benefit from such therapy, provided that their symptoms are severe enough and that their risk of heart attack and stroke is relatively low.

“All of the other studies were largely looking at the effects of long-term hormone therapy,” lead author Dr. Nananda F. Col, from Rhode Island Hospital in Providence, told Reuters Health. “I think that question is no longer particularly interesting because we now know that long-term therapy provides more harm than good.”

The risks and benefits of short-term therapy is a more relevant issue, since “the main indication for hormone therapy is for the relief of menopausal symptoms, which usually only last 1 to 2 years,” Col said. “So, the question isn’t whether you should be taking such therapy for 5, 10, or 20 years, but rather, how safe is it to take such therapy for 2 years for symptom control.”

To investigate the effects of short-term hormone therapy, the authors applied a computer simulation model to data obtained from the Women Health Initiative trial, a major study looking at hormone use in women.

As noted, short-term therapy offered no benefits to women without symptoms and reduced life expectancy by a few weeks. Although women with symptoms also experienced a slight drop in life expectancy, many experienced an improvement in quality-adjusted life expectancy (QALE), a measure of survival that considers quality as well as length of life.

Symptom severity and the risk of heart disease and stroke dictated how likely hormone therapy was to increase QALE. With a low heart disease/stroke risk, menopausal symptoms did not need to be very severe for hormone therapy to extend QALE. Conversely, with a high risk, hormone therapy only increased QALE when symptoms were relatively severe.

The results suggest that short-term hormone therapy is an option to treat menopausal symptoms in women “who are concerned with how long and how well they will live,” Col noted. “If the goal is strictly to live as long as possible then hormone therapy is not a great idea.”

She said she hopes the findings will increase the appropriate use of hormone replacement therapy. “I know a lot of women without symptoms who are receiving such therapy as well as many women with symptoms who are not being treated.”

When asked if the current findings are likely to increase the use of hormone therapy, Col said, “It’s possible that no overall change in usage will occur because a reduction in inappropriate use might offset a rise in appropriate use.”

SOURCE: Archives of Internal Medicine, August 9, 2004.