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Contrary to popular belief, taking sex hormones after menopause does not appear to make many older women feel happier and more vibrant, and may even make some feel worse, researchers reported yesterday.

Only those older women who suffer from hot flashes seem to experience improved emotional well-being from taking estrogen and progestin, according to a large new study.

"This study would suggest that perhaps we should remove quality-of-life benefits from the risk/benefit equation" when women are considering whether to take hormones after menopause, said JoAnn E. Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital, who wrote an editorial accompanying the study in today's issue of the Journal of the American Medical Association.

The women in the study had heart disease and their average age was 67, so the findings may not apply to healthy younger women who take hormones around the time of menopause. Nevertheless, researchers characterized the results as surprising and said they cast doubt on the popular belief, encouraged by drug advertisements, that taking hormones after menopause can make most women feel more youthful and energetic.

"These findings are challenging that perception," Manson said.

The findings are the latest to raise questions about the benefits of hormone replacement therapy, which millions of American women undergo after menopause. Recent studies have cast doubt on whether estrogen can protect against heart disease -- one of the main reasons it had previously been recommended. While estrogen does help prevent bones from thinning, it increases the risk of blood clots, gall bladder disease and uterine cancer. Breast cancer risk also appears to rise after more than five years of use.

Manson and other experts emphasized that the new study confirmed that women suffering from frequent hot flashes do obtain relief from hormone treatment. Hot flashes -- sudden episodes of skin flushing, sweating and a sensation of uncomfortable warmth -- occur in 70 percent of women during menopause and are sometimes severe enough to cause insomnia, fatigue and irritability. In some women they abate after a year or two, while in others they continue for a decade or more. Among study participants with hot flashes, hormone treatment improved symptoms of depression and did not reduce physical well-being.

"Younger women who go on hormone replacement therapy usually do so because of hot flashes," said Jacques E. Rossouw, acting director of the Women's Health Initiative (WHI), a large, ongoing study funded by the National Institutes of Health. "I think that, on balance . . . they'll feel better. Whereas older women in their sixties, particularly if they have pre-existing disease, . . . are less likely to benefit."

The study, led by cardiologist Mark A. Hlatky of Stanford University, examined physical functioning, energy levels, mental health and depressive symptoms among 2,763 women who participated in the HERS trial, a research project originally designed to find out whether women with heart disease would benefit from treatment with estrogen and progestin. Women in the study were randomly allocated to receive either hormones or a placebo. Researchers regularly questioned the women about physical and mental functioning during the three-year study and scored their responses. The HERS trial was funded by Wyeth-Ayerst Research, maker of several hormone products.

In the group as a whole, physical functioning, energy and mental health declined during the study, perhaps reflecting their underlying heart disease. However, at the start of the study, 16 percent of the women said they were bothered by hot flashes, and their baseline indicators of physical and mental health were worse than for the other participants. Among this group, hormone treatment improved depression and overall mental health without significantly affecting energy levels or physical functioning.

In contrast, women without hot flashes who received hormones showed a faster decline in physical functioning than women given a placebo, but no significant difference in mental health or symptoms of depression.

The results suggest that hot flashes can serve as an indicator for identifying those women who may benefit from hormone treatment, Hlatky said. "It may well be that the presence of these flushing symptoms is a marker for women who have a somewhat more severe, symptomatic estrogen deficiency," he said.

"This paper won't change my practice of using hormone therapy for symptomatic women at menopause," said JoAnn V. Pinkerton, an associate professor of obstetrics and gynecology at the University of Virginia. "In that group, whether they have hot flashes or not, I do see an improvement in vaginal dryness, sexuality, feelings of well-being and sleep."

Detailed information about hormones' long-term effects on healthy younger women should be available from the WHI, which has enrolled 27,000 women older than age 49 in a trial comparing hormone treatment with a placebo. The study is expected to run until 2005. Last year, researchers reported that the group given hormones have had slightly higher rates of heart attacks, strokes and blood clots than the placebo group, Rossouw said.

Although estrogen is approved to treat hot flashes and vaginal dryness and to prevent osteoporosis (bone-thinning), Chevy Chase gynecologist James Powers said the makers of hormone products commonly suggest in magazine advertisements that the drugs improve energy, mood and vitality.

"Even our own medical journals are laden with pictures of lovely, attractive women engaged in hard physical activity, as an example of how you can look and feel if you take their product," he said.

Powers predicted that reports of the new findings would trigger a new round of calls and questions from patients about whether to stop taking hormones. "Pretty soon we're going to be left with no really good reason to use estrogen other than prevention of hot flashes, and I think its use will dramatically drop," he said.

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