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Am Fam Physician. 2004;70(4):769-770

Since publication of the Women’s Health Initiative and other trials in July 2002, most experts have recommended against the general use of hormone therapy (HT) and suggest instead to limit HT to short-term management of menopausal symptoms. An estimated 50 to 60 percent of patients discontinued HT in the months following the publication of these trials, although it is unclear how many women subsequently resumed HT. The motivations and experiences of women receiving HT to continue, discontinue, or resume therapy are unclear. Grady and colleagues studied women enrolled in a large health maintenance organization (HMO) to clarify factors in these decisions.

The authors used pharmacy records to identify women 50 to 69 years of age who had been members of the HMO for at least three consecutive years and had obtained at least three prescriptions for HT before July 2002. One thousand women were selected randomly and invited to participate in a 20-minute telephone interview. The interview included sociodemographic information, perceived health status and risk for selected health problems, health and lifestyle habits, and support systems, in addition to detailed information on menopausal symptoms and issues.

Interviews were completed on 670 women. About one half (56 percent) of the group reported attempting to stop HT, and of these women, 280 (74 percent) were not receiving HT at the time of the interview. These women had not taken HT for about six months. About one fourth of women who attempted to stop HT had resumed treatment. These 97 women were compared with the 280 who successfully stopped HT to identify factors in resuming therapy.

Women who discontinued HT abruptly were slightly less likely to resume treatment than those who tapered the dose (24 compared with 29 percent), but this difference was not statistically significant. Initial univariate analysis identified several factors associated with resumption of HT, although further analysis identified only troublesome withdrawal symptoms, hysterectomy, prescription by a nongynecologist, and perceived higher risk of fracture as statistically significant factors. Only 5.3 percent of women who stopped HT reported using any medication or other remedy to prevent or relieve menopausal symptoms.

The authors conclude that about one fourth of women who attempt to stop HT are unsuccessful, and that troublesome withdrawal symptoms are the principal cause of resuming HT.

editor’s note: As we struggle through the great natural experiment of the reversal of expert advice concerning HT, it can be difficult to discern what is actually happening. This study, plus a second from the same group of researchers,1 indicates that just over one half of women attempted to discontinue HT, although a significant percentage of them never completely discontinued it or chose to restart this therapy. Surprisingly, most women were not well informed about the various studies, and most women relied on the media as their main sources of information. The women who continued therapy or resumed it were motivated predominantly by the need to control symptoms such as hot flushes, mood swings, vaginal dryness, incontinence, and depression. A smaller proportion of women were concerned about developing osteoporosis, although the number of women taking bisphosphonates after discontinuing HT was small. Despite all the fuss, physicians do not appear to have met the needs of their postmenopausal patients for information about the risks and benefits of HT and strategies to manage or avoid symptoms in the patients who should, prudently, avoid this therapy.—A.D.W.

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