Since publication of the Women's He...

Since publication of the Women's Health Initiative and other trials in July 2002 greatest in quantity experts have recommended against the general use of hormone therapy (HT) and advise instead to limit HT to short-term management of menopausal symptoms. An estimated 50 to 60 percent of patients discontinued HT in the month following the publication of these trials, although it is unclear to what degree many women subsequently resumed HT The motivations and experiences of women receiving HT to continue, discontinue, or take back therapy are unclear. Grady and colleagues studied women registered 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 undivided 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 pitch uponed health problems, health and lifestyle habits, and support arrangements in addition to detailed information onward menopausal symptoms and issues.

Interviews were complet forward 670 women. About one half (56 percent) of the cluster 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 month About undivided fourth of women who attempted to stop HT had resum treatment. These 97 women were compared with the 280 who luckily stopped HT to identify factors in resuming therapy.

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

The authors gather that about one fourth of women who attempt to stop HT are luckless and that troublesome withdrawal symptoms are the principal cause of resuming HT

Grady D et al. Predictors of difficulty when discontinuing postmenopausal hormone therapy. Obstet Gynecol December 2003;102:1233-9

EDITOR'S NOTE: As we aim through the great natural experiment of the reversal of skilled hand advice concerning HT, it can be difficult to discern what is actually happening. This meditation plus a second from the same arrange of researchers, (1) indicates that just through one half of women attempted to discontinue HT although a significant percentage of them not completely discontinued it or chose to restart this therapy. Surprisingly, greatest in number women were not well informed about the various studies, and in the greatest degree women relied on the media as their main sources of information. The women who continued therapy or resum it were motivated predominantly by the agency of the need to control symptoms of that kind as hot flushes, mood swings, vaginal drynes incontinence, and depression. A smaller proportion of women were troubleed 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 necessitys 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.

REFERENCE

(1) Ettinger B Grady D Tosteson AN, Pressman A, Macer JL general intent of the Women's Health Initiative onward women's decisions to discontinue postmenopausal hormone therapy. Obstet Gynecol December 2003;102:1225-32

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