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Nasty flashbacks

WHI study reports menopausal symptoms may come back after stopping hormone therapy
WHI study reports menopausal symptoms may come back after stopping hormone therapy Photo by Jim Linna

Some women who use a combination of estrogen and progestin to control the symptoms of menopause might find symptoms return when they stop the hormones, according to the latest findings from the Women's Health Initiative (WHI). The Clinical Coordinating Center for the WHI — a nationwide study of women's health that includes a major clinical trial of the risks and benefits of menopausal hormone-therapy — is housed within the Public Health Sciences Division.

Risky businesss

Of the women in the study who had symptoms such as hot flashes, night sweats, pain, or stiffness when the study started, more than half found that these symptoms came back when they stopped menopausal hormone therapy. A smaller percentage of women who did not have symptoms before developed them after stopping the hormones. Women stopped using the study pills when the trial was halted in July 2002, following the discovery that the risks of using these hormones, including increased heart disease, outweighed the benefits such as prevention of fractures. Women who described their symptoms as moderate to severe before the study were more likely to have them come back than women with mild symptoms.

Dr. Judith K. Ockene, of the University of Massachusetts Medical School, Worcester, and other WHI investigators, reported the study results in the July 13, 2005 issue of the Journal of the American Medical Association (JAMA).

"Before this study, we knew little about the effects a woman experiences when she suddenly stops menopausal-hormone therapy use," said Dr. Sherry Sherman of the Geriatrics and Clinical Gerontology Program at the National Institute on Aging. "Now women are learning that their symptoms might return, even after using these hormones for more than five years."

Advice for menopausal years

An estimated 2 million American women go through menopause each year. The WHI found that women ages 50 to 79 years should not use menopausal hormone therapy to prevent heart disease or dementia. But, if women are bothered by moderate to severe menopausal symptoms, the Food and Drug Administration recommends that they can use estrogen (with progesterone if the woman has her uterus) at the lowest effective dose for the shortest time needed to manage them.

The WHI is funded by the National Heart, Lung, and Blood Institute and private donations. The study was conducted in collaboration with the NIA, the National Cancer Institute, the National Institute for Arthritis and Musculoskeletal and Skin Disorders, and Office of Research on Women's Health. The WHI involves 40 clinical centers nationwide, including one in Seattle that is run jointly by the Hutchinson Center and the University of Washington.

As the largest comprehensive clinical study ever funded by the NIH, WHI seeks to find ways to prevent cardiovascular disease, osteoporosis and cancer, all of which have a significant impact on women's health.

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