HRT May Postpone, Not Prevent, Menopausal Symptoms

A study in the July 13, 2005 issue of the Journal of the American Medical Association (JAMA) found that more than half of the women who used hormone replacement therapy (HRT) to control hot flashes and night sweats during menopause had symptoms recur after discontinuing use of the medication.

Millions of women have used hormone supplements for menopausal symptom relief. In 2002, a study conducted by the Women’s Health Initiative (WHI) in which participants took either hormone supplements or placebo pills, was stopped after it found that women taking HRT medication had a small but significant increased risk for stroke, cardiovascular disease, and breast cancer. The WHI findings prompted hundreds of thousands of women to stop taking hormone supplements. Many women found that when they stopped taking HRT medication, their menopausal symptoms returned.

“These study results were not a surprise to symptomatic women who have taken hormone supplements or to any physician who cares for these women,” states Ann Honebrink, MD, a gynecologist at the University of Pennsylvania Health System and director of Penn Health for Women at Radnor.

Out of the original 16,600 WHI study participants, 8,405 were surveyed by mail for eight to 12 months after the study ended. In particular, 21 percent of the hormone supplement users reported severe menopause symptoms afterward, compared with almost five percent of women who had taken placebos.

Dr. Honebrink states, “In the post WHI study era, one of our most challenging clinical issues has been how to best help women who chose to stop hormone supplements minimize menopausal symptoms as they go off the medication.” She continues, “Our experience seems to show that gradually decreasing estrogen dosage over time helps minimize symptoms. However, this is an area where there has been very little objective study. I am sure we will get better and better at designing HRT regimens for symptomatic women and understanding how best to ease symptoms during this transition time.”

The JAMA study also found that menopause symptoms occurred in women both younger and older than the typical ages of 45 to 55. More than one-third of women who reported symptoms after stopping the pills in the WHI study were in their 60s and 70s.

Ann Steiner MD, an obstetrician and gynecologist at the University of Pennsylvania Health System says, “The North American Menopause Society states that nothing works better than estrogen in relieving moderate to severe hot flashes, night sweats, and sleep disturbance due to hot flashes.” She continues, ”Since hot flashes typically last only a few years, the reasons for using hormones may change. The risks may also change.”

The American College of Obstetricians and Gynecologists states that hormone therapy should not be denied based on available data. Women using hormone therapy for several years to treat symptoms may have an improvement in the quality of their lives.

Dr. Steiner concludes, “Both societies agree that the lowest effective estrogen dose should be used for the shortest period of time to alleviate symptoms. The decision to use hormone therapy in menopause is a quality of life issue, and should be made on an individual basis by a woman and her health care provider.”

If you are having difficulty managing symptoms associated with menopause, talk to your health care provider about hormone replacement therapy or alternative remedies to ease symptoms of menopause. To make an appointment with a Penn Ob/Gyn Care physician, please call
1-800-789-PENN (7366) or request an appointment online.

	Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.

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