Effects of hormone replacement therapy on postmenopausal women's mental health

Hormone Replacement Therapy

The Effects of HRT on Post Menopausal Quality of Life

In this study the effects of the use of HRT on the mental health and well being of postmenopausal women will be assessed. The women will complete an e-mail questionnaire to determine if HRT is enhancing their lives. 1/2 the study participants will use HRT therapy while the control group will not use hormone replacement therapy. The researcher will utilize a longitudinal research design to evaluate the psychosocial effects of HRT on women's mental well being and reported quality of life. The results of this study will provide researchers with direction regarding psychological and psychosocial care for women in the postmenopausal stage of life. The researcher predicts that HRT therapy will have positive benefits on the reported quality of life and mental well being of patients receiving treatment.

Introduction

Menopause can have wide reaching effects on women as they enter middle age. The side effects commonly associated with menopause often have negative psychosocial effects on women (Hlatky, et al. 2002). While the physical side effects and psychosocial side effects of menopause itself have been well studied, relatively little literature exists regarding the mental health and well being of women in the post menopausal phase of life.

It is important when examining the effects of menopause and HRT to examine the "benefits, risks and consequences of hormone replacement therapy" as well as to adequately define and understand the stages of menopause including the post menopause stage to provide health counselors with adequate incentive and information to treat patients accordingly (Baldo, Schneider & Slyter, 2003:311).

Postmenopausal women may experience a host of psychological and psychosocial disturbances resulting primarily from hormonal changes that occur during menopause (Gambacciani, et al. 2005). Multiple studies have explored the physical effects of HRT therapy for post-menopausal women, but few have examined the psychological and mental health benefits HRT may pose for women (Hlatky, et al. 2002).

Purpose of Study

The aim or purpose of this study is a psychosocial evaluation of the mental health effects of HRT on postmenopausal women. The intent of the researcher is to find information that doctors can use to improve postmenopausal care from a psychological as well as physical perspective, to help facilitate a holistic approach to health care.

Background to the Problem

While menopause concerns itself primarily with the "cessation of menstruation" the female body in the menopause and post menopause stage go through various responses including mental responses that may be damaging and impact a woman's quality of life (Blado, Schneider & Slyter, 2003). Women are often considered in the post menopausal stage once menopausal transition is complete; this generally occurs after the age of 55 though may vary from woman to woman (Baldo, Schneider & Slyter, 2003). HRT helps replace hormones lost during menopause during all phases of menopause including the postmenopausal phase; research suggests HRT may help relieve short duration symptoms and may help some long-term symptoms (Baldo, Schneider & Slyter, 2003). There are however risks and benefits associated with HRT therapy (Baldo, Schneider & Slyter, 2003).

There are some studies suggesting that HRT can improve varying side effects of menopause, hence improving the quality of life postmenopausal women report. Gambacciani, et al. (2005) for example conducted a correlational analysis of women on HRT to determine the effects of hormone replacement therapy on disturbed sleep. Their study suggests that women on low dose HRT may benefit by realizing a relief in sleep disturbances while on HRT. Added sleep can improve women's quality of life in multiple ways.

Other studies have confirmed a rising interest in women among the ages of 56-59 years in HRT therapy to improve quality of life and the side effects associated with menopause (Seamark & Blake, 2002). The studies that are available with respect to the psychological well being of women on HRT produce mixed results; a study conducted by Skarsgard, Berg, Ekblad et. al (2000) suggests that estrogen therapy alone will not improve the well being reported by postmenopausal women. This however does not suggest that HRT will not improve the well-being of women, as HRT typically employs use of combined hormonal therapy. It does however emphasize the need for further analysis in the area of psychosocial well being and HRT.

Objectives of Study

To accomplish the goals of this study the researcher will engage in a longitudinal analysis of the effects of HRT on postmenopausal women. The women surveyed will use a self report questionnaire to determine whether HRT has positive, neutral or negative effects on post menopausal women's mental health and well being. The researcher will operate under the following hypothesis: Women undergoing HRT treatment will exhibit positive mental health benefits and an elevated sense of well being. Null hypothesis: Women undergoing HRT will not exhibit positive mental health benefits or an elevated sense of well being.

In addition to field research the author will combine the data gathered from this study with evidence supported from a comprehensive literature review studying the effects of HRT on the reported quality of life on patients during their menopausal and post menopausal years.

Significance of Study

This study aims to fill the gap in research that currently exists with respect to HRT and its effects on the reported quality of life on postmenopausal women. At this time relatively little empirical research has been generated in this area. One randomized, placebo-controlled double-blind clinical trial suggests that women undergoing HRT have improved mental health as well as fewer symptoms of depression (Hlatky, et al. 2002). This may be the result of HRT itself or the positive impact HRT has on the side effects of menopause including hot flashes and insomnia. It is vital that moving forward researchers differentiate between the two to determine the difference between the two and analyze whether the effects of hormone therapy depend on pre-existing symptoms or whether emotional improvements are the result of HRT in itself (Hlatky, et al. 2002).

Method

Procedure

Two experimental groups will be developed. 1/2 of the women will take HRT and the 1/2 will not use any HRT. The questionnaire on well being will be rated on a scale of 1-10 measuring the following:

Enjoyment of daily life

Sleep Well.

Awaken Happily.

Socially Active

Diet no sign of anorexia or bulimia.

Anxious.

Sexually active.

Self-esteem.

Level of energy.

Overall satisfaction in life.

Research participants will be assured of their anonymity and the confidentiality of information provided in order to maintain the highest ethical standards when conducting the study. Research participants will also be provided detailed instructions prior to receipt of the email survey and will be asked to sign a written consent affirming that they understand the instructions and provide their consent to participate in this study. Participants will be informed of the purposes of the study and the intended benefits the researcher hopes to gain by conducting this study.

Data Analysis

The researcher will gather all of the information collected from the self report questionnaires and analyze using a variety of techniques including summary, interpretation, classifying and describing. The author will use the data to measure change that occurs among the populations using HRT therapy.

In conducting the study the researcher will undoubtedly run into some obstacles including determining how to measure change in the participants health and well being, examining the extent of change and the attributes of change for purposes of the study (King, 2001). Measuring change is a key concept vital to longitudinal research design (Kind, 2001). As this study is qualitative in nature the data will be presented via narratives, observations and transcripts from the survey to record and measure data appropriately (King, 2001).

The researcher will attempt to explain change and identify causal relationships between the independent and dependent variables. Data managing, reading, describing, interpreting and representing will all be key toward providing adequate data analysis for part of this qualitative longitudinal research analysis

Predicted Results

The purpose of this study is to analyze the effects of HRT on the well being and quality of life reported by post menopausal women. Much of the research currently available on HRT therapy suggests that this study will produce a positive relationship between HRT therapy and women's reported well being.

The researcher predicts that women undergoing HRT will demonstrate elevated mental health benefits including a higher rate of self-esteem, less depression, more 'zest' or energy for life and an improved overall sense of well being. The body of evidence presented thus far from research on menopause suggests that HRT has positive physical benefits for women undergoing treatment. This should lead researchers to assume that the same is true of the psychosocial benefits of HRT.

Little empirical research currently exists however to prove or disprove whether postmenopausal women benefit psychosocially from HRT therapy. The researcher expects the results of this study will confirm the hypothesis and provide a framework for prescribing HRT as a psychosocial therapy in women with emotional or psychosocial symptoms stemming from menopause and during post menopause.

Discussion

Much of the research conducted historically on the effects of menopause confirm multiple physical side effects in women, including: low self-esteem, insomnia, decreased energy, decreased libido, depression and more (Hlatky, et a., 2002). In the past the physical side effects causing these symptoms have been addressed, while relatively little attention has been paid the psychosocial effects of menopause itself.

Psychological and psychosocial disturbances however can reduce the quality of life experienced by post menopausal women. For this reason it is vital that researchers concentrate their efforts on uncovering plausible and effective therapies to improve the mental health and well being of patients during their menopausal and post menopausal years. This researcher will help fill the void that currently exists with respect to research on the psychosocial and psychological effects of hormone replacement therapy. The study will concentrate on women during their post menopausal years combined with examination of the literature available regarding the effects of HRT therapy in women.

Many studies confirm rising interest among the health care community and among menopausal and post menopausal information regarding the effects of HRT therapy on quality of life and mental health and well being (Seamark & Blake, 2002; Gambacciani et a., 2005). In response to this motivation the researcher has developed a longitudinal research study that will measure the effects of HRT on women's quality of life.

The longitudinal design will enable the researcher to collect data on the defined variables over time in order to assess the causal relationship that exists between HRT therapy and the quality of life reported by women participating in the study. Longitudinal designs are vital for adding depth to researcher and providing the researcher knowledge of changes in variables over a defined period of time (King, 200).