Symptom Experience After Discontinuing Use of Estrogen Plus Progestin

Abstract

Recent trial findings indicate that the overall health risks of taking estrogen plus progestin (E + P), usually conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA), exceed the benefits. The primary goals of menopausal hormone therapy (MHT) are to relieve vasomotor symptoms and vaginal dryness. Current recommendations for MHT stress use of the lowest effective dose for the shortest time possible. Little is known about what women experience after stopping MHT. The investigators analyzed data from a cross-sectional survey of 8405 women at 40 clinical centers, enrolled in the Women's Health Initiative, who still were taking CEE + MPA or placebo when MHT was stopped. Participants were questioned 8 to 12 months later. The mean age at the stop date was 69.1 years, and participants had taken study pills for 5.7 years on average. Women responding to the mail survey described a wide range of symptoms after stopping study pills. Those previously randomized to receive CEE + MPA had more symptoms than those assigned to receive placebo. Among symptoms reported by more than 10% of respondents after stopping CEE + MA were, in descending order of frequency: pain or stiffness, feeling tired, vasomotor symptoms, difficulty sleeping, and bloating or gas. Women stopping placebo most often reported pain or stiffness and feeling tired. Younger women were more prone to report emotional or neurologic symptoms, headaches, breast tenderness, vaginal symptoms, and vasomotor symptoms. Those women who reported having moderate or severe symptoms at baseline were more likely to describe the same symptoms after stopping pill use. For instance, 91% of women formerly taking CEE + MPA who reported vasomotor symptoms after stopping MHT had also had these symptoms in the past. The presence of symptoms at baseline was the strongest predictor of moderate or severe vasomotor symptoms and pain or stiffness, even after adjusting for numerous variables, including age at the stop date, baseline MHT use, body mass index, alcohol use, and smoking. In particular, a higher body mass index, past or current use of alcohol, and current smoking made pain or stiffness more likely after discontinuing study pills. The most common measures reported to deal with symptoms were drinking more fluids and starting (or increasing) exercise. Fully 86% of women in each treatment group who used these methods reported a reduction in symptoms. The short-term use of CE + MPA may only relieve postmenopausal symptoms temporarily. Many women, including those who are older, experience recurrent menopausal symptoms after stopping the use of MHT. Further work is needed to devise effective strategies for women whose symptoms recur after discontinuing short-term MHT.