Psychological effects of hormone replacement therapy: a comparison of tibolone and a sequential estrogen therapy

Hormone replacement therapy (HRT) is effective in alleviating vasomotor sym ptoms bur the effect on psychological symptoms is less clear: This study ai med to compare the psychological effects of two regimens of HRT in perimeno pausal women in a randomized, initially double-blind controlled trial. Thirty-eight women reporting climacteric symptoms were randomly allocated i nto either oral conjugated quine estrogen 0.625 mg daily plus progestogen ( norgestrel) 150 mu g for the last 12 days of each 28 day cycle, or tibolone 2.5 mg/day for 28 days. They were assessed using standardised psychologica l assessments. There were no significant differences in changes from baseline between the two types of therapy. For both groups combined there were significant impro vements compared with baseline in vasomotor symptoms in the first month, pl us anxiety, sleep, memory and somatic dysfunction by the second and third m onths, but not in scores of depression. Log linear analysis of weekly score s showed that depression scores were significantly related to improvement i n vasomotor scores independent of type of therapy and time on HRT: Memory p roblems were related to vasomotor symptoms independent of depression. No di fference between the two types of therapy was found, nor any direct effect of HRT on anxiety or depression The results support the domino theory sugge sting that psychological improvement follows alleviation of vasomotor sympt oms.