Short-term Menopausal Hormone Therapy for Symptom Relief: An Updated Decision Model | Breast Cancer | JAMA Internal Medicine | JAMA Network
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Original Investigation
August 9/23, 2004

Short-term Menopausal Hormone Therapy for Symptom Relief: An Updated Decision Model

Author Affiliations

From the Division of General Internal Medicine, Rhode Island Hospital, Brown Medical School, Providence (Dr Col); Harvard Medical School, Boston, Mass (Dr Weber); Leiden University Medical Center, Leiden, the Netherlands (Dr Stiggelbout); Brigham and Women's Hospital, Boston (Dr Chuo); Boston University, Boston (Dr D'Agostino); and Centers for Disease Control and Prevention, Atlanta, Ga (Dr Corso). The authors have no relevant financial interest in this article.

Arch Intern Med. 2004;164(15):1634-1640. doi:10.1001/archinte.164.15.1634

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.