Elsevier

Obstetrics & Gynecology

Volume 100, Issue 6, December 2002, Pages 1209-1218
Obstetrics & Gynecology

Original research
Menopausal symptoms in older women and the effects of treatment with hormone therapy

https://doi.org/10.1016/S0029-7844(02)02369-4Get rights and content

Abstract

Objective

In some women, hot flashes and other symptoms attributed to menopause persist for many years after the cessation of menses. The frequency and severity of such symptoms and response to hormone therapy in older women have not been well documented.

Methods

We used data from the Heart and Estrogen/Progestin Replacement Study, a blinded, clinical trial among 2763 women with documented coronary disease and a uterus who were randomized to receive either conjugated estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg in one tablet or placebo. Participants were queried at baseline and annually regarding menopausal symptoms. Breast symptoms were self-reported, and uterine bleeding was recorded on a daily diary.

Results

Symptoms associated with menopause were relatively common among Heart and Estrogen/Progestin Replacement Study participants, whose average age was 67 years and who averaged 18 years since menopause. At baseline, 16% of women reported frequent hot flashes, 26% vaginal dryness, 10% genital irritation, 55% trouble sleeping, and 53% early awakening. Women assigned to hormone therapy reported less frequent hot flashes, vaginal dryness, and trouble sleeping compared with women assigned to placebo, but more frequent vaginal discharge, genital irritation, uterine bleeding, and breast symptoms. The reporting of breast symptoms among women in the hormone group decreased from 40% at 1 year to 13% by the 4th year. Uterine bleeding was reported by 31% and spotting by an additional 33% of women in the hormone group during the 1st year of treatment; by the 4th year, these proportions had fallen to 11% and 20%, respectively.

Conclusion

Symptoms typically attributed to menopause are common in elderly women. Postmenopausal hormone therapy reduces hot flashes, trouble sleeping, and vaginal dryness, but at standard doses in elderly women is associated with vaginal discharge, genital irritation, uterine bleeding, and breast symptoms.

Section snippets

Materials and methods

The design, methods, and main findings of the Heart and Estrogen/Progestin Replacement Study have been previously published.3 The Heart and Estrogen/Progestin Replacement Study was approved by the Institutional Review Boards at all participating clinical centers. Participants were postmenopausal women less than 80 years with an intact uterus and established coronary heart disease (evidenced by one or more of the following: myocardial infarction, coronary artery bypass graft surgery,

Results

Participants ranged in age from 55 to 88 years, with a mean age of 67 years. The majority of women were white and relatively well educated. All women in the trial had a uterus, and 99% had ovaries. On average, menopause had occurred 18 years prior to the start of the trial. At baseline, there were no differences between the treatment groups in demographics, reproductive history, body mass index, or habits (Table 1).

Symptoms typically associated with menopause were relatively common among the

Discussion

The majority of published investigations of menopausal-type symptoms in women have concentrated on midlife women between the ages of 45 and 60 years.4, 5, 6, 7 The average age of participants in the Heart and Estrogen/Progestin Replacement Study was 67 years, and the oldest participant was 79 years old, making this a unique population in which to study the prevalence of typical menopausal symptoms. The randomized, blinded, placebo-controlled design of the trial is also the most appropriate

Cited by (0)

The Heart and Estrogen/Progestin Replacement Study was funded by Wyeth-Ayerst Research.

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