Ockene JK, Barad DH, Cochrane BB, et al: Symptom experience after discontinuing use of estrogen plus progestin. JAMA 2005;294(2):183-93.
Petitti DB: Some surprises, some answers, and more questions about hormone therapy: further findings from the Women's Health Initiative. JAMA 2005;294(2):245-5 (editorial).
Eight to 12 months after stopping menopausal hormone therapy, women in the Women's Health Initiative study were mailed questionnaires about symptoms and management strategies. The 8,405 women averaged 69 years of age when they stopped the study pills, which they had been taking for an average of 5.7 years. Moderate-to-severe vasomotor symptoms were reported by 21% of hormone users and 4.8% of placebo group respondents (Adjusted Odds Ratio [AOR] 5.82, 95% CI 4.92 to 6.89). Compared with respondents in the placebo group, pain or stiffness symptoms were also more likely in respondents in the estrogen/medroxyprogesterone group (AOR 2.16; 95% CI 2.90 to 3.56). Both vasomotor symptoms (AOR 5.36) and pain or stiffness symptoms (AOR 3.21) were more common in women who reported these symptoms at baseline. Among women who never had vasomotor symptoms, stopping hormone therapy did not appear to induce the symptoms. The study may not be representative of all women who stop hormone therapy since 40% of original Women's Health Initiative participants had stopped study pills before the end of the study. The high frequency of symptoms reported may be a result of abrupt withdrawal from hormone therapy. When hormone therapy is to be stopped, gradual tapering of the dose is suggested.