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Impact of hormone therapy on quality of life after menopause

Utian, Wulf H. MB, BCh, PhD, DSc(Med), FRCOG, FACOG, FICS; Woods, Nancy Fugate PhD

doi: 10.1097/GME.0b013e318298debe
Invited Review

Objective Given the complexity of the literature on quality of life (QOL) and hormone therapy (HT) among women in the menopausal transition and postmenopause, the purposes of this integrative review were to (1) define QOL as a multidimensional construct; (2) review validated instruments for measurement of QOL; (3) review results of HT and QOL clinical trials that have used validated instruments; and (4) assess the effectiveness of HT on QOL, including health-related QOL (HRQOL), menopause-specific QOL (MSQOL), and global QOL (GQOL).

Methods The literature on HT and QOL was searched for definitions of QOL and validated instruments for measuring QOL, and the results were summarized. The purposes of this integrative review were to evaluate the effects of HT on HRQOL, differentiating the effects of HT on GQOL, HRQOL, and MSQOL. As a basis for this review, we searched for published controlled clinical trials in which the effects of HT on QOL were studied using validated QOL instruments, in particular menopause-specific validated instruments.

Results Clear definitions are elucidated. Validated instruments for the measurements of HRQOL, GQOL, and MSQOL are summarized, and the necessity of their incorporation into future research and clinical practice is emphasized. The published effects on QOL of estrogens and progestogens administered to symptomatic and nonsymptomatic women in the menopausal transition and beyond are reviewed.

Conclusions The impact of various health state–related symptoms on HRQOL and GQOL is now an integral component of contemporary health care. Effects of HT include GQOL and HRQOL and should be menopause-specific. There is clearly a need for further studies on menopause and menopause-related therapies using appropriate and validated instruments. Literature review shows that HT provides a significant benefit for MSQOL in midlife women, mainly through relief of symptoms, but treatment also may result in a global increase in sense of well-being (GQOL). HRQOL benefits are contingent on symptom status, as are MSQOL outcomes. Women who are severely symptomatic experience a significant improvement in HRQOL and MSQOL, although this improvement is not significant among women without severe symptoms at baseline measures in clinical trials.

From the 1Case Western Reserve University, Cleveland, OH; 2Gynecology and Women’s Health, The Cleveland Clinic, Cleveland, OH; 3RMR Inc, Cleveland, OH; and 4University of Washington, Seattle, WA.

Received February 27, 2013; revised and accepted April 24, 2013.

Funding/support: None.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Wulf H. Utian, MB, BCh, PhD, DSc(Med), FRCOG, FACOG, FICS, Point East P7, 27500 Cedar Road, Beachwood, OH 44122. E-mail:

© 2013 by The North American Menopause Society.