Consider short-course HRT in menopausal women with systemic lupus

A short course of hormone replacement therapy only slightly increases the natural rate of flares in women with systemic lupus erythematosus, a randomised placebo-controlled trial has concluded.A total of 351 menopausal women with a mean age of 50 and inactive or stable-active SLE were randomised to a year's treatment with standard HRT (conjugated oestrogen and medroxyprogesterone acetate) or placebo. Severe flare of SLE was rare in both groups: it occurred in 13 of 174 patients on HRT (7.5%) and eight of 177 in the control group (4.5%). Nephritis was the most common manifestation. The rate of mild to moderate flares was increased by about 30% on HRT, from an average of 0.84 flares per patient per year on placebo to 1.14 on HRT.Exogenous oestrogens had generally been avoided in women with SLE because of a widely-held view they could activate disease. A hormonal influence over the condition was suggested by its female predominance (being 10 times more common in women than men), disease onset after menarche and before menopause, and exacerbation of disease in animal models by oestrogens. Retrospective studies had indicated HRT could worsen the illness, but they were inadequate because they did not distinguish between severe and less severe flares."Health issues specific to women warrant attention and need to be confronted in patients with SLE," the researchers said. "Although long-term HRT is not currently recommended, short-term salutary effects include treatment of hot flushes and vaginal dryness." Because of premature ovarian failure secondary to cyclophosphamide treatment, some women with SLE might require longer exposures to HRT. Another consideration was their increased risk for osteoporosis after glucocorticoid therapy or secondary to the disease itself.Symptoms related to decreased hormone levels could be a source of serious emotional and physical dysfunction. Because symptoms such as hot flushes were most severe in the perimenopausal period, the relief of symptoms and the brevity of treatment might offset the apparent cardiovascular risk of longer-term HRT that had recently emerged.Reference...