Discontinuation Of Hormone Replacement Therapy Research Articles

A focus on progestogens in hormone replacement therapy

Key content Women receiving estrogen replacement require concomitant progestogen to prevent endometrial hyperplasia and carcinoma. A variety of progestogens are used in hormone replacement therapy (HRT), with different advantages and disadvantages and routes of administration. Progestogenic side effects may be mild but can be debilitating and lead to the discontinuation of HRT, so progestogens should be tailored to the individual woman. Combined HRT containing estrogen and progestogens may be associated with a small increase in the absolute risk of breast cancer, which is not seen in women taking estrogen alone. However, this risk is small, particularly when compared with other modifiable lifestyle risk factors. The addition of certain progestogens to estrogen in the long term may be associated with an increased risk of heart disease, breast cancer and dementia. Learning objectives To understand relative advantages and disadvantages of the different progestogens, regimens and routes of administration. To be aware of current evidence for types, dose and routes of administration of different progestogens. To be able to prescribe progestogens safely in terms of side effect and risk profiles that are individualised to the patient. Ethical issues Well‐informed counselling including absolute, individualised risks for women considering HRT with a progestogenic component is essential to allow patients to make well‐informed choices.

Follow up Case on Breast Reconstruction with ADM

Breast cancer is the most common type of cancer found in women after skin cancer. It is also the second cause of cancer death in women after lung cancer. The incidence of breast cancer has decreased in the last decade due to the discontinuation of hormone replacement therapy in postmenopausal women The majority of women with breast cancer are in an early stage at the moment of detection and are eligible for breast conservation therapy and receive some form of systemic or local adjuvant therapy like chemotherapy or radiotherapy depending on the histological type of the tumor. Acellular dermal matrices or ADM for short are processed dermis that can be used as an adjuvant to local flap reconstruction or as the primary material for reconstruction of the nipple. In this article we discuss the case of a 42 year old woman with breast carcinoma who underwent mastectomy and breast reconstruction with silicone gel implant and ADM and answered a set of questions created to optimize the patient journey from diagnosis to reconstruction and follow-up.

Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome

Abstract Background/Introduction Turner syndrome (TS) is associated with increased cardiovascular risk. Purpose We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS. Methods Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilatation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes-namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep)-and left ventricular (LV) global longitudinal strain (GLS) using speckle tracking echocardiography. Ten healthy female of similar age and BMI served as control group. Results Compared to controls, women with TS on HRT had higher PWV (9.1±2.4 vs. 7.5±0.5m/s), cSBP (130±15 vs. 121±6mmHg), cIMT (0.66±0.06 vs. 0.55±0.05mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2±4 vs. 10.5±2.3%), Ao strain, Ao distensibility and GLS (−18.8±2.7 vs. −21.9±1.5%) (P<0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7±6 vs. 7.2±4%) and reduced PWV (7.8±1.7 vs. 9.1±2.4m/s) and cSBP (123±14 vs. 130±15mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P>0.05 for all comparisons). The percent decrease of cSBP was associated with the percent decrease of PWV (r=0.54) and reversely related with the percent increase of FMD (r=−0.57) (P<0.05 for all comparisons). Conclusion HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure. Funding Acknowledgement Type of funding sources: None.

Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome.

Turner syndrome (TS) is associated with increased cardiovascular risk. We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS. Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes - namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep) - and left ventricular (LV) global longitudinal strain (GLS) using speckle-tracking echocardiography. Ten healthy female of similar age and BMI served as a control group. Compared to controls, women with TS on HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5 m/s), cSBP (130 ± 15 vs. 121 ± 6 mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05 mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2 ± 4 vs. 10.5 ± 2.3%), Ao strain, Ao distensibility and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5%) (P < 0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7 ± 6 vs. 7.2 ± 4%) and reduced PWV (7.8 ± 1.7 vs. 9.1 ± 2.4 m/s) and cSBP (123 ± 14 vs. 130 ± 15 mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P > 0.05 for all comparisons). The percentage decrease of cSBP was associated with the percentage decrease of PWV (r = 0.54) and reversely related with the percentage increase of FMD (r = -0.57; P < 0.05 for all comparisons). HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.

Hormone Replacement Therapy and Development of New Asthma

Hormone replacement therapy (HRT) is prescribed to millions of women worldwide. Previous studies have suggested that HRT has both protective and harmful effects in asthma. Is HRT in menopause associated with new development of asthma? We undertook a nested case-control study based on theDanish registers from June 1, 1995, through December 31, 2018. A diagnosis ofasthma was defined as two redeemed prescriptions of inhaled corticosteroids within2years. HRT was defined as two redeemed prescriptions of female sex hormoneswithin 6months. Data were analyzed using a conditional logistic regression model. We included 34,533 women with asthma vs345,116 women without asthmabetween 40 and 65 years of age. In a multivariate analysis adjusted for age,household income, and educational level, active HRT resulted in a hazardratio(HR) of 1.63 (95%CI, 1.55-1.71; P< .001) of new asthma development.Women with asthma who terminated HRT were likely to discontinuetheir asthma treatment subsequently (HR, 2.12; 95%CI, 1.94-2.33; P<.001). HRT seems to play a role in the development of asthma in mature women. Clinicians prescribing HRT and women receiving HRT should be aware that new airway symptoms can develop, and discontinuation of HRT should be considered.

Effects of hormone replacement therapy on arterial stiffness, endothelial function and myocardial deformation in women with Turner syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: Turner syndrome (TS) is associated with congenital or acquired cardiovascular diseases. Purpose We investigated whether hormone replacement therapy (HRT) affects arterial elastic properties, endothelial function and myocardial deformation in women with TS. Methods In 25 women with TS (age: 29 ± 9years) we measured in the oestrogen phase of HRT cycle and 1 month after discontinuation of HRT: a)Pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI) of the aortic pulse wave, b)perfused boundary region (PBR) of the sublingual arterial microvessels, as a marker of endothelial glycocalyx thickness, c)carotid intima-media thickness (cIMT), d)flow-mediated dilatation (FMD) of the brachial artery and percentage difference of FMD (FMD%), and e)global LV longitudinal strain (GLS) and left atrium (LA) strain using speckle tracking echocardiography. Ten healthy subjects of similar sex, age and BMI served as control group. Results Compared to controls, women with TS under HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5m/s), AI (18 [7 to 27] vs. 5.8 [-10 to 19]%), cSBP (130 ± 15 vs. 121 ± 6mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05mm), FMD (7.2 ± 4 vs. 10 ± 2.3%) and lower LA volume index (14.3 ± 4 vs. 24 ± 13 mL/m²) and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5) (p &amp;lt; 0.05 for all comparisons). PBR was negatively related with FMD% (r=-0.58, p = 0.022) in women with TS under HRT. One month after discontinuation of HRT, all women reduced PWV, AI, cSBP and increased FMD. There were no statistically significant changes in BMI, PBR, cIMT, LA volume index, LA strain and LV GLS (p &amp;gt; 0.05 for all comparisons) (Table). The percent decrease of cSBP was associated with the percent decrease of PWV (r = 0.54) and inversely related with the percent increase of FMD (r=-0.57) (p &amp;lt; 0.05 for all comparisons). Conclusions Hormone replacement treatment in women with TS deteriorates arterial stiffness and endothelial function probably due to increased central arterial blood pressure. Women with Turner syndrome under HRT (n = 25) Women with Turner syndrome one month after discontinuation of HRT (n = 25) p-value PWV, m/s 9.1 ± 2.4 7.8 ± 1.7 0.028 Central SBP, mmHg 130 ± 15 123 ± 14 0.007 PBR, 5-25μm 2.11 ± 0.3 2.12 ± 0.2 0.983 cIMT, mm 0.66 ± 0.06 0.67 ± 0.06 0.947 FMD, % 7.2 ± 4 11.7 ± 6 0.042 LA strain, % 51 ± 12 54 ± 15 0.400 LV GLS, % -18.8 ± 2.7 -19.3 ± 2.3 0.594 Table

Clinical factors predicting the successful discontinuation of hormone replacement therapy in patients diagnosed with primary hypothyroidism

BackgroundAlthough reversible in some patients, primary hypothyroidism is considered a permanent condition requiring lifelong hormone therapy. This study aimed to investigate the factors predicting the successful discontinuation of levothyroxine (L–T4) therapy in patients with primary hypothyroidism.MethodsA retrospective study was performed in primary hypothyroidism patients who met inclusion criteria: patients who maintained stable L–T4 therapy for more than 1 year, following gradual dose reduction of L–T4 based on the clinical decision (L–T4 tapering); patients receiving either no L–T4 or a fixed minimum dose for more than 1 year after L–T4 tapering. Reduction in L–T4 dosage by 12.5–50 μg within 3 months was considered as L–T4 tapering. Serum free T4, TSH, and clinical symptoms were evaluated before, during and after tapering. Logistic regression and decision tree analyses were performed to predict the successful discontinuation of L–T4.ResultsAmong 382 patients, 22.5% and 58.4% showed successful discontinuation (T4–Discontinued) and dose reduction (T4–Reduced) of L–T4 therapy, while other did not obtained any reduction of L–T4 dose (T4–Unchanged). The median number of tapering visit was 1.0 (range, 1.0–4.0). In T4–Discontinued group, the TSH level and the positive rate of anti-thyroperoxidase at the time of L–T4 initiation were lower, the duration of L–T4 therapy was shorter, and the maintenance dose of L–T4 at the time of tapering was lower than those in the T4–Unchanged group. In ultrasonography, normal parenchyma was preserved in the T4–Discontinued group while others showed higher rates of heterogeneous or hypoechoic parenchymal changes. Among those different characteristics, the longer duration of L–T4 therapy and the higher maintenance dose of L–T4 at the time of tapering significantly predicted the failure of discontinuation of L–T4 in multivariate analysis. A decision tree showed that patients with a duration of L–T4 therapy >4.6 years had lower success rate of discontinuation.ConclusionShorter duration of L–T4 therapy and lower L–T4 dose at the time of tapering are the predictable factors for successful L–T4 tapering in stably maintained primary hypothyroidism patients.

MP43-11 PROTECTIVE EFFECT OF POSTMENOPAUSAL HORMONE REPLACEMENT AGAINST UROLITHIASIS

INTRODUCTION AND OBJECTIVE: Menopause is reported to be associated with increased urinary calcium excretion, which may enhance the risk for the development of urolithiasis. However, it remains controversial about whether postmenopausal hormone replacement is a risk factor for formation of urolithiasis. Therefore, we conducted a population-based retrospective cohort study to evaluate the effect of hormone replacement therapy (HRT) on the formation of urolithiasis. METHODS: We used data sourced from Longitudinal Health Insurance Database, which consists of one million randomly selected subjects from the National Health Insurance Research Database of Taiwan. Health Insurance System of Taiwan covers approximately 23 million people (98% of population). Women who were prescribed HRT continually for longer than 3 months during 1997 to 2009 were classified as HRT users; the others were classified as non-users. A total of 13724 HRT users aged ≥ 45 years in 1997 without previous diagnosis of urolithiasis were enrolled. A cohort of 13724 age and metabolic syndrome matched non-HRT users were enrolled as the control group. HRT users were followed from the date of commencing HRT until six months after discontinuation of HRT. Non-users were followed from 1 January 1997 to 31 December 2009. Stratified cox regression model was used to examine the risk of subsequent urolithiasis between HRT users and non-users. RESULTS: Of the sampled patients, HRT users had a significantly lower cumulative incidence of urolithiasis than non-users (4.66% vs 5.94%, p < 0.001). The log-rank test revealed that HRT users had significantly higher urolithiasis-free survival rates than non-users (p < 0.001). HRT users were found to be at 0.78 times the risk of urolithiasis than non-users (95% confidence interval 0.70–0.87, p < 0.001). We further divided the HRT users into two groups according to HRT regimens: estrogen-only vs estrogen combined with progestin. The hazard ratio for urolithiasis in the estrogen-only HRT users compared with non-users was 0.78 (95% confidence interval 0.61–0.99, p = 0.04) and 0.78 (95% confidence interval 0.70–0.88, p < 0.001) in the patients with combined regimen. CONCLUSIONS: HRT use was associated with a lower risk of urolithiasis independent of the regimen difference. Source of Funding: None

Successful Spontaneous Pregnancy and Live Birth in a Woman With Premature Ovarian Insufficiency and 10 Years of Amenorrhea: A Case Report

Background: Primary ovarian insufficiency (POI) is a devastating diagnosis for reproductive-aged women due to the associated infertility and other serious health consequences. Spontaneous pregnancy without hormone replacement therapy (HRT) and/or assisted reproductive technology (ART) rarely occurs in POI patients, particularly in those patients with long-term amenorrhea.Case: On March 4, 2019, a 31-year-old Chinese POI patient visited our hospital for a spontaneous pregnancy after 10 years of amenorrhea and discontinuation of HRT 4 years prior. The patient had menarche at the age of 13, with 3 years of regular menstruation followed by amenorrhea occurring at the age of 20. POI was diagnosed by several hospitals; chromosome examination revealed a normal 46, XX karyotype. Treatment with estradiol valerate and progesterone did lead to resumed menstruation, while amenorrhea resumed after withdrawal of HRT. The patient married at the age of 23 and tried to conceive by HRT until the age of 25; her beta-human chorionic gonadotropin (HCG), estrogen (E2), and progesterone levels were 32987.7~119151.4 mIU/ml, 671.0~>1,000 pg/mL, and 6.6~27.9 ng/ml, respectively. On March 22, 2019, ultrasonography showed an intrauterine pregnancy with a normally developed gestational sac sized 45 × 42 × 32 mm with a 17 mm crown-rump length. On October 29, a 3,400 g healthy girl baby was delivered; the patient had a spontaneous delivery with natural labor.Conclusion: Spontaneous pregnancy is possible in women with POI and 10 years of amenorrhea.

Polypoid endometriosis: a mimic of malignancy.

This an interesting case of an asymptomatic 60-year-old postmenopausal patient with an incidental pelvic mass mimicking a pelvic malignancy on imaging. Biopsy revealed findings consistent with polypoid endometriosis. After discontinuation of hormone replacement therapy, the mass showed decrease in size on follow-up imaging. Polypoid endometriosis is a rare but distinct variant of endometriosis with histopathologic features akin to an endometrial polyp. Clinical and imaging features of polypoid endometriosis differ from classic endometriosis. While classic endometriosis predominates in premenopausal women, polypoid endometriosis more commonly affects peri- to postmenopausal women and is associated with the exposure to Tamoxifen or hormone replacement therapy. Imaging features that aid in the diagnosis of polypoid endometriosis are a T2 hyperintense polypoid mass with signal characteristics similar to endometrium, a T2 hypointense peripheral rim, contrast enhancement pattern mirroring the enhancement of the endometrium, and lack of diffusion restriction. Radiologists should be familiar with polypoid endometriosis because this clinically and morphologically distinct variant may mimic malignant neoplasms on imaging.

Continuation of postmenopausal hormone replacement therapy: comparison of cyclic versus continuous combined schedules.

Discontinuation of hormone replacement therapy (HRT) is much more common than what is reported in randomized, double-blind clinical trials. Our purpose in this retrospective study, using a prescription database, was to compare the continuation rate among women who took cyclic combination therapy adding progesterone to estrogen (CYC-PERT) or continuous combined estrogen progestin therapy (CC-PERT). The study subjects were 1,532 women, ≥45 years old, who initially filled index prescriptions for 0.625 mg conjugated estrogens. They were divided into two groups (CYC-PERT = 644, CC-PERT = 888) on the basis of coprescribed medroxyprogesterone. We found that for all women initiating therapy, 35-40% did not return for a refill and 76-81% stopped therapy within 3 years. Those prescribed CC-PERT initially were more likely to stop than those prescribed CYC-PERT (rate ratio [RR] = 1.20; 95% confidence interval [CI] = 1.06-1.35). Adjustments for age, year of starting medication, cost of medication, and prescriber specialty did not affect the difference in discontinuation between the two regimens (RR 1.18, 95% CI = 1.04-1.34). We conclude that the likelihood of women continuing HRT beyond 3 years of initiation is low. Furthermore, compared with CYC-PERT users, those receiving CC-PERT have a slightly higher probability of discontinuation. Efforts should be made to understand why three quarters of women beginning HRT will stop it long before it can provide major long-term benefit.

The use and discontinuation of hormone replacement therapy in women in South China

Objective: The use of hormone replacement therapy (HRT) started later in China than in European countries. The purpose of the present study was to investigate HRT patterns and reasons for the initiation and discontinuation of HRT among women in South China.Methods: A telephone survey about menopausal status, the use of HRT, reasons for HRT discontinuation and duration of HRT treatment was conducted in 2014.Results: A total of 825 telephone surveys were carried out, and 217 previous HRT users and 390 current users were recruited for this study. Among these 607 subjects, 50.7% of the women sought out HRT for hot flushes, 41.6% for fatigue and 41.5% for sleeplessness. Approximately one-third (35.9%) of the patients abandoned HRT during the following year. The reasons for stopping HRT were mainly fear of breast and uterine cancer (28.4%), reduced menopausal symptoms (22.9%) and the inconvenience of taking pills or seeing a doctor (17.9%). The factors related to HRT discontinuation were the age when HRT was initiated (odds ratio 1.59, 95% confidence interval 1.19–2.13) and education level (odds ratio 0.78, 95% confidence interval 0.62–0.98).Conclusions: The duration of HRT use in women in south China was short, and a high proportion of the women discontinued HRT. Given the high discontinuation rate and the low medical compliance, Chinese health-care providers still have much to do to let women know about the advantages and disadvantages of HRT and to encourage the use of HRT appropriately.

Poster 300: Acute Onset of Psychotic Symptoms Following Abrupt Discontinuation of Hormone Replacement Therapy in a Trangendered Woman with Traumatic Brain Injury: A Case Report

PM&RVolume 9, Issue 9S1 p. S227-S227 Neurological Rehabilitation Poster Hall: Case Report Poster 300: Acute Onset of Psychotic Symptoms Following Abrupt Discontinuation of Hormone Replacement Therapy in a Trangendered Woman with Traumatic Brain Injury: A Case Report Yu M. Chiu DO, Yu M. Chiu DO NYU Rusk Institute of Rehabilitation Med, NY, NY, United StatesSearch for more papers by this authorBaruch Kim resident, Baruch Kim resident NYU Rusk Institute of Rehabilitation Med, NY, NY, United StatesSearch for more papers by this authorXuemue Qu MD, Xuemue Qu MD NYU Rusk Institute of Rehabilitation Med, NY, NY, United StatesSearch for more papers by this authorPrin X. Amorapanth MD, PhD, Prin X. Amorapanth MD, PhD NYU Rusk Institute of Rehabilitation Med, NY, NY, United StatesSearch for more papers by this author Yu M. Chiu DO, Yu M. Chiu DO NYU Rusk Institute of Rehabilitation Med, NY, NY, United StatesSearch for more papers by this authorBaruch Kim resident, Baruch Kim resident NYU Rusk Institute of Rehabilitation Med, NY, NY, United StatesSearch for more papers by this authorXuemue Qu MD, Xuemue Qu MD NYU Rusk Institute of Rehabilitation Med, NY, NY, United StatesSearch for more papers by this authorPrin X. Amorapanth MD, PhD, Prin X. Amorapanth MD, PhD NYU Rusk Institute of Rehabilitation Med, NY, NY, United StatesSearch for more papers by this author First published: 19 September 2017 https://doi.org/10.1016/j.pmrj.2017.08.240Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume9, Issue9S12017 AAPM&R Annual Assembly AbstractsSeptember 2017Pages S227-S227 RelatedInformation

Menopause: A complex and controversial journey.

Menopause is defined as permanent cessation of menstrual periods, determined retrospectively after a woman has experienced 12 months of amenorrhea without any other obvious cause. Over the years, the discourse surrounding the Climacteric was mainly elicited as a "disease of the castrates", as opposed to the feminist views. There has been a large feminist contribution to both the debate of contraception and menopause in the last few years. Over the years, menopause has been treated in a uniform fashion, as a disease, excluding the different circumstances and lived experiences that patients go through during this sensitive period. Every primary care provider should be familiar with the menopausal process and be able to provide adequate care for these women, respecting patient's autonomy and decision making. A brief historical of menopause and hormone replacement therapy (HRT) will be reviewed in this paper. We will also discuss the different views of the menopausal discourse as well as the benefits and risks, compliance rates and reasons for discontinuation of HRT.

Abstract P4-10-08: Can a diagnosis of invasive breast cancer effectively motivate patients to follow healthy lifestyles?

Abstract Background: Survival rates for patients diagnosed with invasive breast cancer have increased dramatically, yet survivors often face a host of adverse health effects. Factors such as obesity, physical inactivity and tobacco use may contribute to decreased survival and quality of life. Behavioral risk factors in patients with and without breast cancer were evaluated to determine whether a diagnosis of invasive disease was sufficient motivation to modify lifestyle choices. Methods: The dataset included female patients diagnosed between 2001-2011with malignant (n=421) or benign (n=230) breast disease and who had baseline and &amp;gt;1-year follow-up information available. Changes in body mass index (BMI), fat intake, exercise frequency, alcohol and tobacco use, caffeine consumption, hormone replacement therapy (HRT) use and frequency of breast self-exam (BSE) were assessed. Random coefficients models were used to examine longitudinal effects of an invasive diagnosis on healthy behaviors. P&amp;lt;0.05 was used to define significance. Results: At diagnosis, patients with invasive cancer were significantly older (59 years), more likely to consume &amp;gt;7 glasses of alcohol/week (7%) but less likely to be using HRT (3%) than those with benign disease (50 years, 3% and 11%, respectively). At baseline, a majority of both invasive and benign patients were overweight, non (current) smokers, and consumed a high fat, highly caffeinated diet and exercised &amp;lt;90 minutes/week, and &amp;gt;50% of both groups performed BSE at least once/month. Exercise, BMI, and caffeine, alcohol and fat intake did not change over time in either invasive or benign groups. Smoking decreased to a similar extent in both invasive and benign patients. In contrast, compliance with monthly BSE increased and HRT use decreased significantly at each time point in the invasive patient group, with no corresponding changes in patients with benign disease. Conclusions: These data support the critical importance of providing education and recommendations about engaging in healthy behaviors by the clinical staff. The two behaviors that improved significantly in patients with invasive breast cancer are both addressed by the clinical staff at Walter Reed National Military Medical Center at the time of diagnosis: with nurse navigators providing education about proper BSE and physicians recommending discontinuation of HRT. Failure to significantly change other behaviors suggests that a diagnosis of breast cancer is not a sufficient motivating factor for the patient to adopt healthier lifestyle choices without provision of education and resources. Our data suggest a need for increased health-related behavioral counseling and support systems to successfully modify personal behaviors, thus improving the health and quality of life of breast cancer survivors. Citation Format: Ellsworth RE, Costantino N, Toro AL, Shriver CD, Ellsworth DL. Can a diagnosis of invasive breast cancer effectively motivate patients to follow healthy lifestyles?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-10-08.

Reproductive endocrinology: Don't be so quick to stop hormone-replacement therapy.

Finnish women <60 years old have an increased risk of death from cardiac events or stroke within a year of stopping hormone-replacement therapy (HRT), compared with women who have not had HRT and with those on current therapy. The safety of the practice of annual discontinuation of HRT should be questioned.

Hormone Replacement Therapy, Likely Neither Angel Nor Demon

PurposeA decline in breast cancer incidence has been attributed to the reduction in hormone replacement therapy (HRT) prescriptions since the publication of the landmark WHIT paper in 2003. Concurrently, a relationship between HRT and cerebrovascular disease incidence has also been suggested. No generalized analysis of HRT prescription rates and breast cancer incidence rates that included more than seven years of data. We hypothesized that detailed analysis of SEER data would clarify the relationship between HRT use and breast cancer incidence. Given the large decline in HRT prescription rates uncovered, analyses of potential complications were also conducted, with the understanding that a small effect or one limited to a subpopulation, such as a single race, might not be detected.MethodsIncidence rates (per 100,000 women) and standard errors for ductal and lobular breast carcinomas, and endometrioid /endometrial carcinomas in women over 50 years were obtained from the Surveillance, Epidemiology, and End Results (SEER) database 1992–2012. From the Medical Expenditure Panel Survey 1996–2012 weighted counts and standard errors of hormone replacement therapy (HRT) prescriptions for women over 50 years were obtained. Using the National Hospital Discharge Survey (NHDS), 1996–2010 weighted counts and standard errors of femoral neck fractures, total hip replacements, acute myocardial infarctions, and cerebral infarctions were obtained for 50+ year men and women. Weighted counts and standard errors were divided by US census figures and multiplied by 100,000. Joinpoint regression was used to analyze rates.Main ResultsBeginning 2001, HRT prescription rates dropped dramatically, 2001–2012 AAPC -14.9 (95% CI -17.4, -12.4). Breast cancer rates, which began to decline in 1999, increased after 2003; 2012 rates were similar to those seen in 2001 for both ductal, AAPC 0.1 (-0.4, 0.6) and lobular, AAPC 0.5 (-0.4, 1.5), carcinoma. Endometrial carcinoma rates increased, 2001–2012 AAPC 3.5 (3.1, 3.8), arguing against a negative effect of HRT discontinuation of endometrial carcinoma. Tests for parallelism failed to detect APC differences among genders for femoral neck fractures (P = 0.24), for total hip replacements (P = 0.11), for myocardial infarctions (P = 0.10), or for cerebral infarctions (P = 0.19), precluding any assignment of general effect on these disorders by HRT.ConclusionsUsing SEER data, we demonstrated that changes in breast cancer rates cannot be explained by HRT prescription rate changes.

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

Background: Prescriptions for hormone replacement therapy (HRT) declined following the publication of the Women's Health Initiative study. The number of women who experience recurrence of menopausal symptoms after discontinuation of long-term HRT (LT-HRT), the length of time these symptoms last and the preferred alternative treatments remain unknown. Methods: This prospective 3-year follow-up study analyses the prevalence and intensity of menopausal symptoms that occur in young postmenopausal women who discontinued LT-HRT. Symptoms were evaluated using the Menopause Rating Scale. Results: Women (254) who discontinued LT-HRT (mean use: 6.9 ± 2.3 years) were recruited. Mean age at menopause was 48.1 ± 3.4 years. Mean age at discontinuation was 56.8 ± 3.7 years. 23% of the women were lost to follow-up. Of the remaining 196 women, 93% experienced a recurrence of menopausal symptoms within the first year, 25% resumed low-dose HRT, 62% used vaginal estrogens, 54% used phytoestrogens, and 2% used alternative therapies. A decrease in symptom prevalence and intensity was observed during the 3-year follow-up. Conclusions: Symptoms re-appeared in a significant proportion of patients within the first year after discontinuation of LT-HRT. However, after 3 years, the majority of these women were asymptomatic. Patients who discontinue LT-HRT may require a more detailed follow-up immediately after the discontinuation of treatment.

Discontinuation of hormone replacement therapy after myocardial infarction and short term risk of adverse cardiovascular events: nationwide cohort study

Objective To assess the risk of adverse cardiovascular events in women who discontinue hormone replacement therapy after myocardial infarction compared with those who continue.Design Nationwide register based cohort study.Setting All...

Danish Findings Show Neither Benefit nor Harm of HRT After Myocardial Infarction

Debate continues about the cardiovascular benefits or harms of hormone replacement therapy (HT). Despite guideline recommendations to discontinue HT in patients with coronary artery disease, as many as 80% of women taking HT at the time of hospitalization for myocardial infarction (MI) continue HT after discharge. To assess whether continuation or discontinuation of HT after MI affects risk …