Background: Prescriptions for hormone replacement therapy (HRT) declined following the publication of the Women's Health Initiative study. The number of women who experience recurrence of menopausal symptoms after discontinuation of long-term HRT (LT-HRT), the length of time these symptoms last and the preferred alternative treatments remain unknown. Methods: This prospective 3-year follow-up study analyses the prevalence and intensity of menopausal symptoms that occur in young postmenopausal women who discontinued LT-HRT. Symptoms were evaluated using the Menopause Rating Scale. Results: Women (254) who discontinued LT-HRT (mean use: 6.9 ± 2.3 years) were recruited. Mean age at menopause was 48.1 ± 3.4 years. Mean age at discontinuation was 56.8 ± 3.7 years. 23% of the women were lost to follow-up. Of the remaining 196 women, 93% experienced a recurrence of menopausal symptoms within the first year, 25% resumed low-dose HRT, 62% used vaginal estrogens, 54% used phytoestrogens, and 2% used alternative therapies. A decrease in symptom prevalence and intensity was observed during the 3-year follow-up. Conclusions: Symptoms re-appeared in a significant proportion of patients within the first year after discontinuation of LT-HRT. However, after 3 years, the majority of these women were asymptomatic. Patients who discontinue LT-HRT may require a more detailed follow-up immediately after the discontinuation of treatment.

1.
Simon JA, Hsia J, Cauley JA, Richards C, Harris F, Fong J, Barrett-Connor E, Hulley SB: Postmenopausal hormone therapy and risk of stroke: the Heart and Estrogen-Progestin Replacement Study (HERS). Circulation 2001;103:638-642.
2.
Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J, Writing Group for the Women's Health Initiative Investigators: Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321-333.
3.
Lawton B, Rose S, McLeod D, Dowell A: Changes in use of hormone replacement therapy after the report from the Women's Health Initiative: cross-sectional survey of users. BMJ 2003;327:845-846.
4.
Austin PC, Mamdani MM, Tu K, Jaakkimainen L: Prescriptions for estrogen replacement therapy in Ontario before and after publication of the Women's Health Initiative study. JAMA 2003;289:3241-3242.
5.
Haas JS, Kaplan CP, Gerstenberger EP, Kerlikowske K: Changes in the use of postmenopausal hormone therapy after the publication of clinical trials. Ann Intern Med 2004;140:184-188.
6.
Ness J, Aronow WS, Newkirk E, McDanel D: Use of hormone replacement therapy by postmenopausal women after the publication of the Women's Health Initiative trial. J Gerontol Med Sci 2005;60:460-462.
7.
Parazzini F, Progetto Menopausa Italia Study Group: Trends of determinants of hormone therapy use in Italian women attending menopause clinics, 1997-2003. Menopause 2008;15:164-170.
8.
Lukes A: Evolving issues in the clinical and managed care settings on the management of menopause following the Women's Health Initiative. J Manag Care Pharm 2008;14:S7-S13.
9.
Cobin RH, Futterweit W, Ginzburg SB, Goodman NF, Kleerekoper M, Licata AA, Meikle AW, Petak SM, Porte KL, Sellin RV, Smith KD, Verso MA, Watts NB, AACE Menopause Guidelines Revision Task Force: American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocr Pract 2006;12:315-337.
10.
North American Menopause Society: Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause 2010;17:242-255.
11.
Gompel A, Rozemberg S, Barlow DH, EMAS Board Members: The EMAS 2008 update on clinical recommendation on postmenopausal hormone replacement therapy. Maturitas 2008;61:227-232.
12.
Ockene JK, Barad DH, Cochrane BB, Larson JC, Gass M, Wassertheil-Smoller S, Manson JE, Barnabei VM, Lane DS, Brzyski RG, Rosal MC, Wylie-Rosett J, Hays J: Symptom experience after discontinuing use of estrogen plus progestin. JAMA 2005;294:183-193.
13.
Ness J, Aronow WS, Beck G: Menopausal symptoms after cessation of hormone replacement therapy. Maturitas 2006;53:356-361.
14.
Heikkinen J, Vaheri R, Timonen U: A 10-year follow-up of postmenopausal women on long-term continuous combined hormone replacement therapy: update of safety and quality-of-life findings. J Br Menopause Soc 2006;12:115-125.
15.
Shrader SP, Ragucci KR: Life after the women's health initiative: evaluation of postmenopausal symptoms and use of alternative therapies after discontinuation of hormone therapy. Pharmacotherapy 2006;26:1403-1409.
16.
Lindh-Astrand L, Bixo M, Hirschberg AL, Sundstrom-Poromaa I, Hammar M: A randomized controlled study of taper down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms. Menopause 2010;17:72-79.
17.
Heiss G, Wallace R, Anderson GL, Aragaki A, Beresford SA, Brzyski R, Chlebowski RT, Gass M, LaCroix A, Manson JE, Prentice RL, Rossouw J, Stefanick ML: WHI Investigators. Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA 2008;299:1036-1045.
18.
Grady D, Sawaya GF: Discontinuation of postmenopausal hormone therapy. Am J Med 2005;118:163-165.
19.
Haimov-Kochman R, Barak-Glantz E, Ein-Mor E, Arbel R, Brzezinski A, Milwidsky A, Hochner-Celnikier D: Duration not severity of the climacteric syndrome predicts resumption of hormone therapy after discontinuation: a prospective cohort study. Hum Reprod 2006;21:2450-2454.
20.
Grady D, Ettinger B, Tosteson AN, Pressman A, Macer JL: Predictors of difficulty when discontinuing postmenopausal hormone therapy. Obstet Gynecol 2003;102:1233-1239.
21.
Grady D: A 60-year-old woman trying to discontinue hormone replacement therapy. JAMA 2002;287:2130-2137.
22.
Aslan E, Baqis T, Kilicdaq EB, Tarim E, Erkarli S, Kuscu E: How best is to discontinue postmenopausal hormone therapy: immediate or tapered? Maturitas 2007;56:78-83.
23.
Haskell SG, Bean-Mayberry B, Gordon K: Discontinuing postmenopausal hormone therapy: an observational study of tapering versus quitting cold turkey: is there a difference in recurrence of menopausal symptoms? Menopause 2009;16:494-499.
24.
Suffoletto JA, Hess R: Tapering versus cold turkey: symptoms versus successful discontinuation of menopausal hormone therapy. Menopause 2009;16:436-437.
25.
Horner E, Fleming J, Studd J: A study of women on long-term hormone replacement therapy and their attitude to suggested cessation. Climacteric 2006;9:459-463.
26.
Heinemann LA, Potthoff P, Schneider HP: International versions of the Menopause Rating Scale (MRS). Health Qual Life Outcomes 2003;30:1-28.
27.
North American Menopause Society: Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement of The North American Menopause Society. Menopause 2007;14:168-182.
28.
North American Menopause Society: Amended report from the NAMS Advisory Panel on postmenopausal hormone therapy. Menopause 2003;10:6-12.
29.
Skouby SO, Al-Azzawi F, Barlow D, Calaf-Alsina Erdogan Ertüngealp J, Gompel A, Graziottin A, Hudita D, Pines A, Rozenberg S, Samsioe G, Stevenson JC: European Menopause and Andropause Society. Climacteric medicine: European Menopause and Andropause Society (EMAS) 2004/2005 position statements on peri- and postmenopausal hormone replacement therapy. Maturitas 2005;51:8-14.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.