Effects of Physical Exercise and Estrogen on Health-related Quality of Life
Objective: The purpose of this study was to evaluate the isolated and associated effects of estrogen therapy (estradiol valerate 1 mg/d orally) and physical exercise (moderate aerobic exercise, 3 h/wk) on health-related quality of life (HRQOL) and menopausal symptoms among women who had undergone hysterectomy.
Design: A 6-month, randomized, double-blind, placebo-controlled clinical trial with 44 postmenopausal women who had undergone hysterectomy. The interventions were physical exercise and hormone therapy (n = 9), being sedentary and hormone therapy (n = 14), physical exercise and placebo (n = 11), and being sedentary and placebo (n = 10). HRQOL was assessed by a Brazilian standard version of the Medical Outcome Study Short-Form Health Survey and symptoms by Kupperman Index at baseline and after 6 months.
Results: There was a decrease in symptoms in all groups, but only groups who performed physical exercise showed an increase in quality of life. Analysis of variance showed that changes in physical functioning (P = 0.001) and bodily pain (P = 0.012) scores over the 6-month period differed significantly between women who exercised and women who were sedentary, regardless of hormone therapy. Hormone therapy had no effect, and there was also no significant association between physical exercise and hormone therapy in HRQOL.
Conclusions: Physical exercises can reduce menopausal symptoms and enhance HRQOL, independent of whether hormone therapy is taken.

Menopause can be defined as a permanent interruption of ovarian function and the end of a women's reproductive potential. More than an isolated event, the decrease in estrogen levels is a universal process that takes part in many physiologic and metabolic changes, affecting not only the reproductive tissues but other systems of women's bodies. Moreover, menopause can involve important changes in the social and psychological aspects of women's lives.

Although there is a wide variation in experiencing menopausal symptoms, for most women, menopause is associated with health complaints. There is strong evidence that the menopausal transition causes vasomotor symptoms. In Western societies, hot flushes are the most common symptom that affects approximately 75% of perimenopausal and postmenopausal women. Hot flushes and night sweats often result in discomfort, resulting in a negative impact on social life, psychological health, well-being, and quality of life. Besides the symptoms, menopause is later also associated with an increased risk of developing cardiovascular diseases and osteoporosis, both well-known leading causes of death in women, mainly after menopause. Recently the American Heart Association Heart Disease and Stroke Statistics reinforced this point. The increased prevalence of heart disease, especially coronary atherosclerosis, in this population is related to cholesterol and triglyceride elevation in addition to lifestyle, cardiovascular risk factors, and genetic background.

Nowadays, quality of life is considered an important outcome that reflects the impact of health conditions, diseases, and treatments from the subjective perspective of patients. Thus, the evaluation of quality of life is an important component in providing a more complete picture of the effects of menopause as well as evaluating the possible benefits of different treatments and therapies. What is more, this evaluation can help develop health policies.

Although it remains controversial, many authors have been supporting the association between menopause and poorer quality of life. This could be a consequence of biological modifications, symptoms, and sociocultural factors.

The main treatment indicated to diminish or relieve negative effects of menopause is hormone therapy. Many studies have confirmed the positive effects of hormone therapy on quality of life.

Apart from hormone therapy, physical exercise can provide a wide range of health benefits for postmenopausal women; they represent a positive effect on quality of life that can affect symptoms, body mass index, and coronary heart disease risk. However, no studies have explored the associated effects of hormone therapy and physical exercise on health-related quality of life (HRQOL).

The aim of this study was to evaluate the isolated and associated effects of estrogen therapy and physical exercises on HRQOL and symptoms among women who had undergone hysterectomy.