Stopping hormone therapy worse than not starting?

NEW YORK (Reuters Health) - If you're considering starting hormone treatments to ease the hot and bothersome symptoms of menopause, keep in mind that you could suffer even more if you ever stop the therapy, new research says.

The findings of the study, part of the large-scale Women's Health Initiative (WHI), may give postmenopausal women pause before starting replacement of their body's declining levels of estrogen.

"Evidence seems to suggest that 25 percent or more of women who start hormones might find it very difficult to stop them -- ever," study co-author Marcia Stefanick, a chair of the WHI's executive committee, told Reuters Health by email.

Researchers randomly assigned more than 10,000 postmenopausal women who had undergone a hysterectomy - removal of the uterus -- to take either estrogen therapy or a hormone-free placebo pill. All women then reported their symptoms before starting the therapy and again one year later.

A portion of the participants also filled out surveys before and after stopping the pills. One out of every three women noted troubling symptoms at the start of the study, with fewer complaints among older women.

After the first year, women on estrogen pills experienced about half as many hot flashes, 40 percent fewer night sweats and 20 percent less vaginal dryness compared to those taking the placebo.

However, the active therapy also led to significantly more breast tenderness, report the researchers in the journal Menopause.

Other problems appeared when the study ended. About 7 percent of women who did not report hot flashes before starting estrogen therapy experienced them after stopping about 7 years later, compared to less than 2 percent of women on the placebo.

The team also saw more joint pain and stiffness among estrogen users following the end of the study, whether or not the women had those symptoms when they enrolled.

The study is a companion to another WHI analysis, which concluded that a combination therapy of estrogen plus progestin could cause more harm than good in postmenopausal women who had not had a hysterectomy. After stopping therapy, five times as many women taking the hormones complained of menopausal symptoms compared to those assigned the placebo.

Further, hormone-treated women developed more breast cancers, and had more heart attacks and other events related to clogged arteries.

Based on that trial, doctors are now discouraged from prescribing hormone therapy only to prevent chronic diseases. The authors - one of 11 of whom reports having been funded by drug companies that make hormone replacement therapy -- note that the new analysis adds support to the recommendation not to start hormone therapy for women without menopausal symptoms. The exception is the prevention of the bone-thinning disease osteoporosis.

Fortunately, as both WHI trials demonstrated, menopause symptoms usually subside on their own without the help of a pill. "The hot flashes would have stopped within 3 to 5 years for a substantial proportion of these women had they never started hormones in the first place," said Stefanick.

SOURCE: http://journals.lww.com/menopausejournal/Abstract/publishahead/Menopausal_symptom_experience_before_and_after.99229.aspx Menopause, online May 24, 2010.