Healthy Woman: Hormone Withdrawal Woes

Five years ago, hormone therapy was recommended to postmenopausal women almost as a matter of course as a way to protect them from age-related disease and to improve their overall quality of life. How times have changed.

In mid-2002, a major study revealed hormone therapy that combined estrogen and progestin increased heart disease and breast cancer risk and didn't affect well being. Prescriptions for hormone therapy dropped from 90 million to an estimated 57 million within a year.

Then, later data from the study, the so-called Women's Health Initiative, or WHI, showed risk of dementia doubled in women 65 and older who were taking postmenopausal hormone therapy. Prior to this finding, some women were taking hormones, in part, because they were under the impression that it might prevent Alzheimer's disease.

Now, just this week, the estrogen-only phase of the WHI was ended prematurely because not only did it not effect risk of heart disease, but also because it raised the risk of stroke. Even more women are now likely to discontinue hormone therapy.

Yet coming off the hormones is not always easy for women. It's estimated that about a quarter of women who stop hormone therapy resume taking them to ease debilitating withdrawal symptoms such as hot flashes. Quitting is especially difficult for women who have been taking hormones for 10 years or more.

Below, Marcia Stefanick, a professor of medicine at Stanford University and coauthor of a recent study about the national use of hormone therapy, discusses the medical community's latest approach to postmenopausal hormone therapy.

Was the drop in the use of postmenopausal hormone therapy significant? Yes, I think that there was a significant response to new evidence. I think the greatest response from the WHI was specific to combination estrogen/progestin therapy as opposed to estrogen-only therapy. (Estrogen-only therapy is prescribed to women who do not have a uterus.) This was appropriate as the women on estrogen/progestin therapy were the only group that the data related to.

It terms of the women who stayed on the therapy, it's a matter of teasing apart the estrogen-only from the estrogen and progestin combination therapy. My suspicion is that the estrogen-only women are the group that is primarily keeping the numbers up.

Why might women choose to stay on postmenopausal hormone therapy? There are still a lot of women who continue their hormones. They are either very happy on hormones or their physicians are still of the opinion that they are better off being on the hormones.

And there is a reason to be on hormones. Certainly many relatively young women going through menopause find those symptoms intolerable. Some women who came off the hormones probably had even worse symptoms than they had before they started.

A Kaiser Foundation study showed that one in four women in the group that came off went back on. So at least 75 percent of women who were on hormones didn't have a very good reason to be on them with respect to their own comfort level.

How do you think most women stopped taking postmenopausal therapy? I think the July 2002 data and the media attention to the risks caused many women to call their doctors and say, "I'm stopping my pills," and by and large physicians supported that decision to stop. And from that point on physicians no longer promoted hormones except for women who really had the symptoms for which the hormones are indicated.

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