Postmenopausal hormone therapy and quality of life

Quality of life in postmenopausal women: the impact of depressive and anxiety disorders

OBJECTIVE

Psychiatric symptoms are frequently present in postmenopausal women. The present study aimed to investigate the impact of depressive and anxiety disorders on the quality of life (QoL) of postmenopausal women.

METHOD

The study sample consisted of 342 postmenopausal women who presented to the Gynecology Outpatient Clinic. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition was used to determine depressive and anxiety disorders. The participants' QoL level was assessed by means of the World Health Organization QoL Assessment-Brief (WHOQOL-BREF).

RESULTS

Subjects without a diagnosis of depressive or anxiety disorder had significantly higher points in all domains of WHOQOL-BREF. According to linear regression analysis, all evaluated disorders except social phobia and specific phobia were independently associated with lower scores for at least one dimension of the QoL scale. However, major depression, dysthymic disorder, and generalized anxiety disorder predicted all domains of WHOQOL-BREF.

CONCLUSION

Depressive and anxiety disorders, particularly major depression, dysthymic disorder, and generalized anxiety disorder, seem to be considerable factors affecting the QoL in postmenopausal women.

Quality of life in women with premature ovarian failure

A cross-sectional and case-control study with a matching for age was performed to evaluate quality of life in 58 women with a diagnosis of premature ovarian failure (POF) and 58 women with normal ovarian function paired for age (± 2 years) (control group). In both groups were excluded women with chronic diseases and iatrogenic or genetic causes. Quality of life was evaluated using the WHOQOL-BREF. Although there were no statistically significant differences in quality of life in general between the two groups, there were statistically significant differences in mean scores in the physical health [61.3 ± 18.0 and 72.8 ± 16.4 for the POF and control groups, respectively (p < 0.0001)] and psychological domains [64.2 ± 16.7 and 69.3 ± 14.1, respectively (p = 0.0455)]. Having POF represented an approximately 2.5-fold greater risk of scoring poorly in the physical health and psychological domains. No statistically significant differences were found between the groups with respect to the social relationships or environment domains or for overall health. Women with POF have more difficulty with respect to their physical health and psychological aspects, indicating a need to provide adequate psychosocial and clinical support for these women to minimize the repercussion of this diagnosis on their activities and quality of life.

Bayesian meta-analysis of hormone therapy and mortality in younger postmenopausal women

BACKGROUND

There is uncertainty over the risks and benefits of hormone therapy. We performed a Bayesian meta-analysis to evaluate the effect of hormone therapy on total mortality in younger postmenopausal women. This analysis synthesizes evidence from different sources, taking into account varying views on the issue.

METHODS

A comprehensive search from 1966 through January 2008 identified randomized controlled trials of at least 6 month's duration that evaluated hormone therapy in women with mean age <60 years and reported at least one death, and prospective observational cohort studies that evaluated the relative risk of mortality associated with hormone therapy after adjustment for confounding variables.

RESULTS

The results were synthesized using a hierarchical random-effects Bayesian meta-analysis. The pooled results from 19 randomized trials, with 16,000 women (mean age 55 years) followed for 83,000 patient-years, showed a mortality relative risk of 0.73 (95% credible interval 0.52-0.96). When data from 8 observational studies were added to the analysis, the resultant relative risk was 0.72 (credible interval 0.62-0.82). The posterior probability that hormone therapy reduces total mortality in younger women is almost 1.

CONCLUSIONS

The synthesis of data using Bayesian meta-analysis indicates a reduction in mortality in younger postmenopausal women taking hormone therapy compared with no treatment. This finding should be interpreted taking into account the potential benefits and harms of hormone therapy.

Physical activity, menopause, and quality of life: the role of affect and self-worth across time

OBJECTIVE

Physical activity has been shown to enhance quality of life (QOL); however, few investigations of these effects exist in women undergoing the menopausal transition. The present study examined the long-term effects of physical activity on menopause-related QOL and tested the mediating effects of physical self-worth and positive affect in this relationship.

METHODS

Middle-aged women previously enrolled in a 4-month randomized controlled trial involving walking and yoga, and a control group completed a follow-up mail-in survey 2 years after the end of the trial. The survey included a battery of psychological and physical activity measures, including measures of menopausal symptoms and menopause-related QOL. Longitudinal linear panel analysis was conducted within a covariance modeling framework to test whether physical self-worth and positive affect mediated the physical activity-QOL relationship over time.

RESULTS

At the end of the trial, physical activity and menopausal symptoms were related to physical self-worth and positive affect, and in turn, greater levels of physical self-worth and positive affect were associated with higher levels of menopause-related QOL. Analyses indicated that increases in physical activity and decreases in menopausal symptoms over the 2-year period were related to increases in physical self-worth (betas = 0.23 and -0.52, physical activity and menopausal symptoms, respectively) and, for symptoms, also to decreased positive affect (beta = -0.47), and both physical self-worth (beta = 0.34) and affect (beta = 0.43) directly influenced enhancements in QOL (R = 0.775).

CONCLUSIONS

The findings support the position that the effects of physical activity on QOL are mediated, in part, by intermediate psychological outcomes and that physical activity can have long-term benefits for women undergoing the menopausal transition.

The cost-effectiveness of hormone therapy in younger and older postmenopausal women

PURPOSE

To evaluate the health and economic outcomes of hormone therapy in younger and older postmenopausal women.

METHODS

We developed a cost-effectiveness model to evaluate outcomes associated with hormone therapy in younger and older postmenopausal women, using data sources from published literature through March 2008. The target population was 50-year-old and 65-year-old women given hormone therapy or no therapy, and then followed over their lifetime. Primary outcomes measured were quality-adjusted life-years (QALYs) and incremental cost per QALY gained.

RESULTS

For the base-case analysis, hormone therapy for 15 years in the younger cohort resulted in a gain of 1.49 QALYs with an incremental cost of $2438 per QALY gained, compared with no therapy. The results for younger women were robust to all sensitivity analyses, and treatment remained highly cost-effective (<$10,000 per QALY gained) within the range of individual assumptions used. Treatment durations of 5 years and 30 years also were highly cost-effective. In the older cohort, treatment for 15 years resulted in a net gain of 0.11 QALYs with a cost of $27,953 per QALY gained. However, a loss of QALYs was seen in the first 9 years. The results for older women were sensitive to many of the assumptions used.

CONCLUSIONS

Hormone therapy for 5 to 30 years in younger postmenopausal women increases quality-adjusted life-years and is cost-effective. Hormone therapy started in later years results in a loss of quality-adjusted life for several years before a net gain can be realized.

Do estrogen or selective estrogen receptor modulators improve quality of life for women with postmenopausal osteoporosis?

Osteoporotic fractures result in significant deficits in health-related quality of life (HRQOL). The accumulation of deficits resulting from osteoporosis and fractures is now recognized as a major cause of reduced HRQOL in women after the menopause and in later life. Some of these same postmenopausal women may also have deficits in HRQOL related to vasomotor symptoms during the menopausal transition. Although estrogen therapy has not been shown to improve overall HRQOL in late postmenopausal women in randomized, controlled trials, it may improve menopausal symptoms. In contrast, selective estrogen receptor modulators (SERMs) such as raloxifene may increase vasomotor symptoms. Although estrogen is not indicated for the primary prevention of osteoporosis, estrogen therapy may be considered for the postmenopausal woman at risk of osteoporotic fracture who is symptomatic and who is not at high risk of breast cancer or cardiovascular events. Raloxifene decreases risk of invasive breast cancer and may be considered in women at high risk of breast cancer. Decision making about osteoporosis treatment should also consider the impact of the treatment on HRQOL.