Hormone therapy users report healthier lifestyles

Menopausal women using hormone therapy reported healthier diet, exercise and sleep habits than non-users in a study of more than 10,000 women.

The menopause transition is associated with a higher risk of chronic health conditions and symptoms including hot flushes and problems affecting the urinary and genital systems.

Hormone therapy is often used to manage these symptoms, but it remains unclear whether it affects health outcomes directly or indirectly through changes in health behaviours.

Previous research has produced mixed results, with some studies suggesting that postmenopausal women pay greater attention to maintaining a healthy lifestyle.

 

The cross-sectional analysis examined whether menopause status and hormone therapy use were linked to diet, physical activity and sleep duration.

A cross-sectional study assesses participants at one point in time. It can identify associations but cannot establish whether one factor directly caused another.

Diet, exercise and sleep are described as modifiable health behaviours because people may be able to change them to improve their health.

The researchers found that postmenopausal women who had never used hormone therapy reported eating less fruit and vegetables.

Women who had never used the treatment were also 19 per cent less likely to meet guidelines for muscle-strengthening activity.

Sleep duration was shorter among postmenopausal women who had never used hormone therapy.

Compared with premenopausal and perimenopausal women, the likelihood of meeting sleep guidelines was 14 per cent lower among never-users, 26 per cent lower among current users and 24 per cent lower among past users.

Perimenopause is the transitional period before menopause, when hormone levels and menstrual periods can change.

Researchers said these findings may be linked to higher levels of follicle-stimulating hormone among postmenopausal women who do not use hormone therapy.

They may also relate to lower levels of oestradiol, a form of oestrogen, which have previously been associated with poorer sleep.

Hot flushes and urogenital symptoms can also disrupt sleep, although hormone therapy may ease these symptoms.

Dr Stephanie Faubion, medical director for The Menopause Society, said: “This large observational study underscores that women who use hormone therapy tend to adopt overall healthier lifestyles.

“Although this association may partly reflect better symptom control enabling healthier behaviours, healthy-user bias is likely a significant contributor.

“Women who choose to use hormone therapy are often more proactive in their healthcare and may systematically differ from nonusers in socioeconomic resources, access to care, and health literacy.

“This largely explains why early observational studies of hormone therapy suggested cardiovascular benefits that were not confirmed in subsequent randomised, controlled trials.”