Four years of hormone-replacement therapy (HRT) started soon after the onset of the menopause improved depression and anxiety in healthy women without promoting or worsening cardiovascular disease, the results of the KEEPS study show.
The study, presented at the North American Menopause Society 2012 Annual Meeting held in Orlando, Florida, US, involved 700 women who took either oral conjugated equine oestrogens (Premarin®) 0.45 mg/day (lower than the 0.625 mg/day used in the Women’s Health Initiative [WHI] study), transdermal oestradiol (Climara®) 50 micrograms/day, or placebo. Women taking the active oestrogens received 200 mg of micronised progesterone for 12 days each month.
As expected, both types of hormone therapy relieved menopausal symptoms, such as hot flushes and night sweats and had favourable effects on bone mineral density compared with placebo.
WHI results hinted that the timing of therapy may be important. In general, the women in WHI started hormone therapy at an older age (mean age 63 years) than in most previous studies. In KEEPS, however, all the women were within three years of menopause when they entered the study (mean age 52) and had no evidence of cardiovascular disease.
In KEEPS, oestrogen therapy did not increase blood pressure levels. Oral oestrogen had small but favourable effects on high-density lipoprotein and low-density lipoprotein but increased triglycerides and C-reactive protein. Transdermal oestrogen had no effect on biomarkers but improved glucose levels and insulin sensitivity. Carotid ultrasound showed no differences in the progression of arterial wall thickness among the three treatment groups. There was a non-significant trend toward less progression of coronary artery calcium in the hormone therapy groups.