Low-Dose Hormone Replacement Therapy for Hot Flashes–Reply–I

Abstract

In reply: We agree, in general, with Dr Mikhail's comments. The results of the Women's Health Initiative led to the conclusion that long-term HRT should not be recom mended for women at this time because of the increased risk of strokes, cardiovascular disease, venous thromboembolic disease, and breast cancer.1Rossouw JE Anderson GL Prentice RL Women's Health Initiative Investigators et al.Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial.JAMA. 2002; 288: 321-333Crossref PubMed Scopus (13969) Google Scholar As noted in our article, the Women's Health Initiative investigators specified that the trial did not address the short-term risks and benefits of hormones given for the treatment of menopausal symptoms. The short-term use of estrogen-based hormonal therapy in this setting effectively reduces hot flashes by approximately 80% to 90%, and many women are able to discontinue HRT within 1 to 2 years without recurrence of their hot flash symptoms. Given the Women's Health Initiative results, certainly the lowest hormone dose that effectively relieves symptoms should be used. The findings in the study by Utian et al2Utian WH Shoupe D Bachmann G Pinkerton JV Pickar JH Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and medroxyprogesterone acetate.Fertil Steril. 2001; 75: 1065-1079Abstract Full Text Full Text PDF PubMed Scopus (338) Google Scholar revealed that low-dose combination HRT (0.3 mg/d of CEE plus 1.5 mg/d of MPA) is as effective as higher-dose treatment of hot flashes and should be considered the standard initial dosage for treatment of menopausal symptoms. Dose titration can be considered for women whose symptoms do not respond to low-dose treatment. Whether low-dose HRT is safer for long-term use than the conventional dosages used in the Women's Health Initiative study is unknown. Low-Dose Hormone Replacement Therapy for Hot FlashesMayo Clinic ProceedingsVol. 78Issue 3PreviewTo the Editor: I read with interest the excellent review by Shanafelt et al1 on the pathophysiology and treatment of hot flashes. In the last section of the article, the authors recommended the initiation of hormone replacement therapy (HRT) for postmenopausal women with severe hot flashes. I would like to comment on the dose of HRT used for that purpose. Full-Text PDF