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An Updated Decision Model

Nananda F. Col, MD, MPP, MPH; Griffin Weber, MD, PhD; Anne Stiggelbout, PhD; John Chuo, MD; Ralph D'Agostino, PhD; Phaedra Corso, PhD

Arch Intern Med. 2004;164:1634-1640.

Background  Hormone therapy (HT) provides the most effective relief of menopausal symptoms. This therapy is associated with a decreased risk of osteoporosis and colorectal cancer but increased risks of cardiovascular disease (CVD), venous thrombosis, and breast cancer. Our objective was to identify which women should benefit from short-term HT by exploring the trade-off between symptom relief and risks of inducing disease.

Methods  A Markov model simulates the effect of short-term (2 years) estrogen and progestin HT on life expectancy and quality-adjusted life expectancy (QALE) among 50-year-old menopausal women with intact uteri, using findings from the Women's Health Initiative. Quality-of-life (QOL) utility scores were derived from the literature. We assumed HT-affected QOL only during perimenopause, when it reduced symptoms by 80%.

Results  Among asymptomatic women, short-term HT was associated with net losses in life expectancy and QALE of 1 to 3 months, depending on CVD risk. Women with mild or severe menopausal symptoms gained 3 to 4 months or 7 to 8 months of QALE, respectively. Among women at low risk for CVD, HT extended QALE if menopausal symptoms lowered QOL by as little as 4%. Among women at elevated CVD risk, HT extended QALE only if symptoms lowered QOL by at least 12%.

Conclusions  Hormone therapy is associated with losses in survival but gains in QALE for women with menopausal symptoms. Women expected to benefit from short-term HT can be identified by the severity of their menopausal symptoms and CVD risk.

From the Division of General Internal Medicine, Rhode Island Hospital, Brown Medical School, Providence (Dr Col); Harvard Medical School, Boston, Mass (Dr Weber); Leiden University Medical Center, Leiden, the Netherlands (Dr Stiggelbout); Brigham and Women's Hospital, Boston (Dr Chuo); Boston University, Boston (Dr D'Agostino); and Centers for Disease Control and Prevention, Atlanta, Ga (Dr Corso). The authors have no relevant financial interest in this article.

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