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Stopping hormone therapy may have its own risks

By Kathryn Doyle

NEW YORK (Reuters Health) -Though long-term hormone replacement therapy has serious health risks, going off the medication may lead to a return of menopausal symptoms and increased risk for high blood pressure, according to a new study.

Taking estrogen or estrogen and progesterone hormones can help alleviate some bothersome symptoms of menopause, like hot flashes, vaginal dryness and trouble sleeping, but the United States Preventive Services Task Force recommends that postmenopausal women avoid the therapy due to an increased risk of heart disease, stroke, dementia and breast cancer.

The risks were widely publicized after the Women's Health Initiative (WHI) study results were published in 2002.

Despite those risks, "for some women there may be definite benefits (of hormone therapy) that have not been realized," lead author Dr. Michelle Warren of Columbia University Medical Center in New York told Reuters Health.

The new study, which was funded by Pfizer, manufacturer of Prempro and Premarin hormone replacement drugs, included 310 postmenopausal women aged 56 to 73 who had been on hormone therapy for at least five years.

The women were divided into three groups: those on continuous hormone therapy, those who stopped taking the hormones briefly and went back on them and women who stopped taking the hormones permanently.

About 16 percent of women taking hormones were also taking blood pressure medication compared to 24 percent of women who had stopped for good, which suggests the hormones may have a protective effect against high blood pressure.

That's one of the potential unknown benefits of the therapy, which can be "quite safe" for women under 60 years of age who only take the hormones for two to five years, Warren said. Her study mainly included women at healthy weights with few other risk factors, who are likely to experience the most benefits, she said.

Another potential benefit of staying on hormone therapy is better work performance. For some women, severe menopause symptoms return after hormone therapy is stopped. Previous studies have found menopause symptoms associated with decreased work ability and more sickness absences from work.

In this study, women taking hormones were about 20 percent more likely to be employed and scored higher on a quality of life scale, according to results published in the journal Menopause.

"The quality of life issue has not been well addressed but it's a big issue," Warren said.

For a small number of women, menopause can come with severe mood problems and sleep disruption that can end relationships or careers, and non-hormonal options aren't enough, she said. Hormonal therapies usually cost between $10 and $85 per month without insurance.

"Women stopped hormones in droves (after the WHI), but 1 out of 4 restarted," because they were having severe symptoms affecting quality of life, Dr. JoAnn Pinkerton, medical director of the Midlife Health Center at the University of Virginia in Charlottesville, told Reuters Health.

Pinkerton was not surprised by the results of the new study, but said she will add in the potential connection to blood pressure to her discussions with patients and figuring out what path is best for each individual patient, she said.

Some doctors stopped prescribing hormone therapy altogether after the WHI, making it hard for some women to deal with their severe symptoms, Warren said.

Pinkerton suggests women with bothersome symptoms sit down with a menopause specialist and discuss the safest options, which include lower doses of estrogen delivered by a gel, patch or cream, and lower or intermittent doses of progesterone. What's right for one woman may not be best for another, she said.

"Just as the decision to go on hormones is dependent on many factors, the decision to go off and stay off can be individualized," Pinkerton said.

SOURCE: http://bit.ly/ZvsRgD Menopause, online April 8, 2013.

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