A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms

Abstract

Inger Sundström-Poromaa and Mats Hammar, A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms., 2009, Menopause (New York, N.Y. Design: Eighty-one postmenopausal women with EPT due to hot flashes were randomized to tapering down or abrupt discontinuation of EPT. Vasomotor symptoms were recorded in selfregistered diaries and resumption of hormone therapy (HT) was asked for at every follow-up. HRQoL was assessed with the Psychological General Well-being Index (PGWB).Results: Neither the number nor the severity of hot flashes or HRQoL or frequency of resumption of HT differed between the two modes of discontinuation of EPT during up to 12 months of follow-up. About every other woman had resumed HT within one year. Women who resumed HT after four or twelve months reported more deteriorated HRQoL and more severe hot flashes following discontinuation of therapy than women who did not reuptake HT. Conclusion:Women who initiate EPT due to hot flashes may experience recurrence of vasomotor symptoms and impaired health related quality of life after discontinuation of EPT regardless of abrupt or taper down discontinuation. Since in addition to severity of flashes decreased wellbeing was the main predictor of the risk to resume HT it seems important to also discuss quality of life in parallel with efforts to discontinue HT. Keywords: Menopause, hormone therapy, discontinuation of therapy, vasomotor symptoms, Health-related Quality of life (HRQoL)Running title: Discontinuation of hormone therapy Lindh-Åstrand et al Introduction: As many as 50 to 70 % of women in the Western world experience menopause-related symptoms such as hot flashes and sweating 1-4 during the menopausal transition. Sleep disturbances and vaginal discomfort are other common symptoms associated with the menopausal transition 3, 4 . These symptoms may affect health-related quality of life (HRQoL) 5,6 . Previous observational 7-9 and randomized controlled studies (RCT) investigating secondary endpoints 10, 11 reported benefits of long-term use of hormone therapy (HT). The results from the Women's Health Initiative (WHI) 12 and Heart Estrogen/Progestin Replacement Study (HERS) 13 dramatically changed treatment recommendations of HT in both the USA and Europe and led to updated guidelines from national and international menopause societies. According to the current guidelines, HT is the most effective and safe therapy for symptomatic women in early postmenopause with moderate to severe vasomotor symptoms, but should be used in the lowest effective dose and for the shortest possible duration. It is necessary to stop HT to evaluate whether the symptoms persist or have been resolved. An individual risk profile should be considered for every woman before initiation and after a failed attempt to discontinue HT 14,15 . There is a lack of evidenced-based recommendations on how best to discontinue HT. Different types of gradual discontinuations are suggested either by "dose taper" i.e. d...

Menopausal Symptoms after the Discontinuation of Long-Term Hormone Replacement Therapy in Women under 60: A 3-Year Follow-Up

“…The well-being of women following the discontinuation of HRT and the administration of alternative therapeutics remain subjects of debate [12,13,14,15,16,17]. Approximately 75% of women who discontinue HRT do not suffer from important symptoms, but in some of these women, vasomotor complaints are a major difficulty [7].…”

Effect of abrupt discontinuation versus gradual dose reduction of postmenopausal hormone therapy on hot flushes

“…Moreover, these authors concluded that neither the number nor the intensity of the hot flushes differed for the different methods of hormone therapy withdrawal 12 .…”

Factors Associated with Successful Discontinuation of Hormone Therapy

“…25 A randomized trial of 87 Swedish women using estrogen plus progestin found no difference in postdiscontinuation hot flash frequency or severity among those randomized to quit abruptly versus a 4-week taper. 26 Similarly, Cunha found no differences in the Blatt-Kupperman Menopausal Index or the hot flush score among women randomized for abrupt cessation or 2 or 4 months of a lowered dose. Half of the women in each group resumed HT within a year.…”