Hormone therapy, alternative medicine are not linked to QOL in midlife women

Contemporary OB/GYN JournalVol 68 No 02
Volume 68
Issue 02

For women at midlife with vasomotor and/or genitourinary symptoms of menopause, neither hormone therapy nor complementary alternative medicine (CAM) was linked to an improvement in quality of life (QOL), according to a secondary analysis of the ongoing Study of Women’s Health Across the Nation (SWAN) published in the journal Menopause.

However, treatment-by-race/ethnicity interaction was significant for self-reported QOL (= .034 at baseline, P =.044 longitudinal). Among White women, self-reported QOL was much higher in hormone-therapy users than in those who used neither therapy (P = .030; 95% CI, 0.01-0.21). By contrast, Black women using hormone therapy only had significantly lower self-reported QOL compared with Black women using neither treatment(P = .027; 95% CI, −0.40 to −0.02).

“It was not surprising that White women reported higher use of hormone therapy and higher QOL than Black women,” said Monica Christmas, MD, SWAN’s lead investigator, principal investigator for the analysis, and an associate professor of obstetrics and gynecology at UChicago Medicine in Illinois. “But it was surprising that Black women, who have been shown to have more frequent, severe vasomotor symptoms for longer duration of time, reported lower QOL with use of hormone therapy.”

Christmas, who is also director of the menopause program and the Center for Women’s Integrated Health at UChicagoMedicine, added, “Anecdotally, in my clinical practice over the past 20 years, I have noticed significant racial/ethnic differences in severity and intensity of menopausal symptoms, along with differences in preference for treatment of those symptoms. There is also a paucity of data on menopause care in certain populations.”

Christmas noted that SWAN is an ideal databank because the study recruited a large, racially/ethnically diverse cohort that has been followed for more than 20 years.

“Women were asked if they had menopausal symptoms, and if so, did they take anything to alleviate their symptoms,” Christmas told Contemporary OB/GYN®. “Often participants of studies are only asked what prescription medications they take; however, SWAN asked participants about CAM modalities as well.”

In addition, participants were asked about QOL. “This allowed our team to look into associations between menopause symptoms, treatments, and perceived QOL,” Christmas said.

The cross-sectional and longitudinal analyses of QOL included 2514 women from SWAN who completed a CAM-use questionnaire and QOL assessments at baseline and every 1 to 2 years from 2002 to 2013. During a mean 7.8 years of follow-up, 29% of the cohort reported using hormone therapy for a mean 2.4 years, whereas 32% reported CAM use for a mean 2.1 years.

Christmas noted that the CAM/integrative medicine industry is “booming, despite lack of efficacy in randomized controlled trials. Therefore, clinicians should be counseling patients on the lack of efficacy and possible harm associated with some of these products.”

In addition, recognizing racial/ethnic differences when treating menopausal symptoms is paramount, according to Christmas. “Clinicians should be cognizant of these differences when counseling patients,” she said. “More research is also needed to investigate the basis of these differences. Are they due to patient preference, or are there some inherent biases in
clinician practices?”

Christmas stressed that menopause transition is connected to troublesome symptoms that can have a major impact not only on QOL, but also on professional and personal relationships and overall health and function.

“With life expectancy of over 80 years in developed countries, almost half of a woman’s life could be postmenopausal,” she said. “For symptomatic women, it is imperative we have a better understanding of treatment practices and preferences.”


Christmas M, Janssen I, Joffe H, Upchurch D, Santoro N, Kravitz HM. Menopause hormone therapy and complementary alternative medicine, quality of life, and racial/ethnic differences: the Study of Women’s Health Across the Nation (SWAN). Menopause. 2022;29(12):1357-1364. doi:10.1097/GME.0000000000002087

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