Abstract and Introduction
Abstract
Objective: Many women stopped hormone therapy (HT) or estrogen therapy (ET) after the Women's Health Initiative results were published in 2002. This study assessed the incidence of hypertension, weight gain, and dyslipidemia; conditions that predispose to chronic diseases; medication use; and quality of life in women who used HT/ET for at least 5 years and subsequently stopped its use compared with those who continued its use.
Methods: A retrospective study was conducted. All consenting eligible women (aged 56-73 y) in physicians' offices were interviewed, and measurements of weight, height, waist-to-hip ratio, and body fat were performed. Standardized quality-of-life and menopausal and medical questionnaires were administered. Three groups were compared: group 1, women who have remained on HT/ET; group 2, women who have resumed HT/ET after stopping for at least 6 months; and group 3, women who have stopped HT/ET and have not resumed.
Results: One hundred fifty-nine women were enrolled in group 1, 43 women were enrolled in group 2, and 108 women were enrolled in group 3. Women's characteristics were similar, except that group 3 was 1.5 (0.5) years older and had 4.4 (0.7) years less HT/ET use than groups 1 and 2. Utian Quality of Life scores were significantly lower in group 3 (83.4 [12.5]) than in groups 1 and 2 (87.6 [13.3], P < 0.02), particularly in the occupational satisfaction scale. About 16.6% and 16.3% of women in groups 1 and 2 were on antihypertensive medication, respectively, compared with 27.4% in group 3 (P < 0.04).
Conclusions: Discontinuation of HT/ET may predispose some women to the risk of hypertension and may affect their quality of life.
Introduction
Few studies have examined the effects of hormone withdrawal on women using hormones for menopausal symptoms. Since the results of the Women's Health Initiative (WHI) were published in July 2002, a large number of women have stopped hormone therapy (HT) because of their concerns about the risks of heart attacks and breast cancer. This discontinuation of HT is probably the largest sudden decline in the use of a medication in the history of American medicine. The initial drop in sales ranged between 32% and 38%, with a continued annual decline of approximately 6% and an eventual 45% reduction in use that has stabilized without a further recent decline. These women present a unique population, and these events represent an unparalleled opportunity to answer epidemiologic questions on risks and benefits in those women who initiated therapy at menopause and subsequently chose to stop HT. The hypoestrogenic menopausal state is associated with weight gain, changes in body composition, increased visceral fat, and increased secretion of inflammatory factors, and predisposes women to chronic diseases such as diabetes, heart disease, and metabolic syndrome. The time elapsed since 2002 presents an optimal interval to observe the consequences of this experience, as risk surfaced after 5 years of therapy in the estrogen + progestin (E + P) arm of the WHI trial and after 8 years in the estrogen-alone trial. Women who were aged 49 to 64 years and at fairly low risk for chronic diseases when the WHI results were announced are now aged 57 to73 years and therefore at greater risk for cardiovascular and other chronic diseases. Some data suggest that women are at high risk for chronic diseases after menopause and that HT may delay some of these effects. This retrospective study aimed to compare the prevalence of conditions that predispose to chronic diseases (obesity, hypertension, hyperlipidemia, and diabetes, all components of metabolic syndrome) and medication use among women currently aged 56 to 73 years who used HT for at least 5 years and subsequently stopped, with comparable women who continued this therapy being drawn from the same practices. If HT had a preventive or delaying role, women stopping HT would be at greater risk for developing chronic diseases than the cohort continuing on hormones. We also assessed quality of life and medical morbidity.