HT decreases life expectancy, but benefits may exceed risks

Combination hormone replacement therapy (HT) slightly decreases a woman's life expectancy, probably on the order of several days. But, when quality of life without menopausal symptoms is factored into the equation, HT provides an equivalent or greater number of quality-adjusted years of life than no therapy at all.

Using a Markov decision-analysis model, researchers compared the quality-adjusted life expectancy with and without combination HT in three cohorts of women with menopausal symptoms over a 20-year period.

They found that for women who use HT for less than 5 years, symptoms would need to affect a woman's quality of life only slightly—not even as much as seasonal allergies—to make HT use beneficial in terms of quality-adjusted years of life. The authors of the study advise that women and their clinicians considering the use of HT include such information in a complete discussion about the benefits and risks of therapy.

Kim C, Kwok YS. Decision analysis of hormone replacement therapy after the Women's Health Initiative. Am J Obstet Gynecol. 2003;189:1228-1233.