IN JULY 2002, INITIAL RESULTS FROM THE WOMEN’S HEALTH Initiative (WHI) randomized trial of combined estrogen plus progestin hormone therapy (CEE MPA) and follow-up data from the Heart Estrogen/progestin Replacement Study (HERS) were published within weeks of each other. The increased risks associated with CEE MPA therapy for postmenopausal women drew wide attention not only among the clinical professions, but also among the media, including front-page articles in major newspapers, feature stories in major weekly news magazines, and coverage by virtually all major television news programs. Neither women taking hormones nor their physicians could escape the media message: postmenopausal hormone therapy is dangerous. Many women taking hormones were urged by their physicians to stop taking these medications immediately or decided to stop taking them on their own. At the time, anecdote, not evidence, answered women’s question, “What can I expect?” In this issue of JAMA, Ockene et al report the results of a systematic collection of data on symptoms after discontinuing CEE MPA or placebo pills from 8405 of the 9351 participants in WHI who were still taking their assigned study drug on the stop date of the intervention (July 8, 2002). The WHI data and safety monitoring board had concluded in May 2002 that the risks of CEE MPA treatment outweighed the benefits and recommended early stopping of the study. These data should be of great interest both for counseling women currently taking hormones who may be reluctant to stop, and for providing information about symptoms commonly attributed to the decline in ovarian hormones that occurs with the menopausal transition. After discontinuing use of CEE MPA or placebo, women most commonly reported hot flashes or night sweats, pain and stiffness, and fatigue and difficulty sleeping, but nearly 36.7% of women reported neither moderate nor severe symptoms after they stopped taking CEE MPA. Among women who did not have a history of vasomotor symptoms at baseline, only 6.4% reported symptoms after discontinuing use of CEE MPA. Among the 63.3% of the WHI participants who reported at least 1 moderate or severe symptom after discontinuing use of CEE MPA, a wide range of strategies—many of them lifestyle changes, such as drinking more fluids, starting or increasing exercise, practicing yoga, meditation or breathing exercises, and using fans or air conditioners—were perceived to be quite helpful in relieving or coping with symptoms. So what can women who stop taking hormone therapy expect? Many will not experience unbearable symptoms, and those women whose symptoms are troubling may find relief with self-initiated, nonhormonal remedies. Symptom reports from the women in the WHI study who stopped taking placebo were also relatively common. Prior studies have shown that women who are randomized to the placebo group of trials investigating a variety of treatments for menopausal symptoms often improve. This is true not only for hormone therapies but also for treatments that are classified as complementary or alternative. In the WHI study, 40.5% of women who had been assigned to the placebo group reported a moderate or severe symptom after ceasing placebo use. Among women who had the symptom at baseline, 21.3% reported vasomotor symptoms, and 38.3% reported pain or stiffness after they stopped taking the placebo. This “placebo withdrawal effect”—combined with the data suggesting that simple lifestyle changes relieve some symptoms in at least some women—raises questions about the physiological basis of some of the symptoms that have always been associated with the estrogen-deficient state. Which of these are true consequences of cessation of estrogen production by the ovary? Accumulating evidence suggests many symptoms commonly attributed to estrogen deficiency are not. For example, in an examination of evidence for a causal association between ovarian aging and senescence and symptoms commonly attributed to menopause, including vasomotor symptoms (hot flashes and night sweats), vaginal dryness, sleep disturbances, mood symptoms (depression,