Contrary to what medicine has always maintained, new data from the American Heart and Estrogen/Progestin Replacement Study (HERS) indicate that HRT does not, in general, improve the quality of life for postmenopausal women.

The HERS trial included 2763 women - with an average age of 67 - who had coronary artery disease.

The researchers measured the effects of HRT (oestrogen and medroxyprogesterone) on 1380 participants (compared with 1383 women who received a placebo as controls) in four areas: physical activity, energy levels, mental health and depression.

At the beginning of this multicentre, double-blind randomised clinical trial, 230 women in the HRT group and 204 controls suffered hot flushes. Quality-of-life scores were significantly worse for these women compared with those who didn’t have hot flushes.

Three years later, women with flushes in the HRT group had increased their original quality of life scores and reduced their symptoms of depression compared with the controls.

However, in the women without hot flushes who took HRT, physical function and energy levels worsened more than in the controls.

Thus, these findings are consistent with the idea that, among women with menopausal symptoms, HRT typically improves quality of life but, among those who don’t have such symptoms, the quality of life is adversely affected by HRT.

Further research is needed into the effects of HRT in younger women as well as in women who don’t have coronary disease (JAMA, 2002; 287: 591-7).