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Discontinuing HT may be detrimental for some women
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22nd Annual Meeting of NAMS
WASHINGTON, D.C. — Discontinuing hormone therapy may place certain women at risk for cardiovascular disease and may also be linked to decreased professional satisfaction, a speaker said here.
"After results of the Women's Health Initiative were published in 2002, large numbers of women discontinued menopausal HT and estrogen at that time," Michelle P. Warren, MD, medical director of the Center for Menopause, Hormonal Disorders and Women's Health at Columbia University and Endocrine Today Editorial Board member, said during a presentation. "The initial drop was 33% and continued at a rate of almost 6% per year. This is the largest single decrease in use of a medication over a short period in American history."
HT, however, may have significant benefits in the prevention of chronic diseases, such as diabetes, CVD and metabolic syndrome, as the treatment has been shown to ameliorate the weight gain and negative changes in body composition that occur during the hypoestrogenic menopausal state. Therefore, Warren and colleagues conducted a retrospective cohort study to investigate the potential ramifications of discontinuing HT in this population.
To date, 278 women born between 1938 and 1953 have completed the study. All women had used HT, estrogen or estrogen plus progestin for at least 5 years before continuing therapy, discontinuing for at least 6 months and then resuming therapy, or completely discontinuing therapy. Average BMI was 24, mean age at enrollment was 64 years and mean age at which HT was initiated was 49 years, according to information provided by the researchers. The majority of participants were highly educated and 96.2% were white. Of the women who discontinued treatment, 77.3% cited adverse media coverage as the primary reason, whereas physician recommendations accounted for 18%, cancer for 8.6% and various other reasons for 7.8%, Warren reported.
Results indicated that women who continued HT had lower levels of total and LDL cholesterol, but when compared with the group who resumed treatment, both endpoints were significantly lower. When combining all participants who were currently using HT, total and LDL cholesterol did not differ from those who discontinued. There were also no differences in HDL and triglycerides between groups.
"The most significant finding was medication use," Warren said. "Those who discontinued were almost twice as likely to be on antihypertensive medicines when compared with those who resumed and those who continued."
Data also suggested that women using HT had better quality of life as measured by the Utian Quality of Life scale. In particular, these participants scored higher on the 35-point occupational satisfaction scale subset, which gauges professional satisfaction, than those who discontinued therapy. This group was also less likely to experience vasomotor symptoms and vaginal dryness.
"In conclusion, discontinuation may place women at risk for hypertension, which may be an early indication of metabolic syndrome or loss of nitrous oxide induced by endothelial relaxation, and women remaining on HT score higher on quality of life scales," Warren said.
For more information:
- Warren MP. S-2. Presented at: the 22nd Annual Meeting of the North American Menopause Society; Sept. 21-24, 2011; Washington, D.C.
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