title: Hormone therapy discontinuation: physician practices after the Women's Health Initiative.
abstract: OBJECTIVE
  No guidelines or randomized trials address best practices for hormone therapy (HT) discontinuation.
  
  
  METHODS
  We conducted a survey study to explore HT discontinuation practices at Group Health and Harvard Vanguard, large integrated health systems in the Northwest and Northeast United States, focusing on differences between specialties and study site.
  
  
  RESULTS
  The response rate to the written questionnaire (mailed between December 2005 and May 2006) was 78.5% (736/928); this article reports the results for 483 eligible physicians. To discontinue oral HT, most physicians (91%) advised tapering, not immediate cessation (8%), and most (60%) suggested decreasing both dose and days per week. Almost 60% of physicians reported no experience with tapering patches. Harvard Vanguard physicians were more likely than Group Health physicians to encourage discontinuing HT and less likely to recommend resuming HT when a woman's symptoms returned after discontinuing HT. Physicians were most strongly influenced by their own experience (48%), advice from colleagues (25%), and the woman's preference (19%) when choosing a discontinuation strategy; only 2% relied on research evidence. Physicians endorsed various approaches to manage symptoms after HT discontinuation, most often behavioral changes (44%) and increased exercise (37%), and these approaches were more often endorsed by Harvard Vanguard physicians and obstetrician/gynecologists than Group Health physicians or family practitioners or internists.
  
  
  CONCLUSIONS
  Two health plans in the Northwestern and Northeastern United States have no standard protocol for HT discontinuation. Physicians customized approaches, influenced by their location, colleagues, and specialty. Research is needed to guide approaches to HT discontinuation.
authors.affiliation: Group Health Research Institute, Seattle, WA, USA. newton.k@ghc.org
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Newton
authors.forename: Susan D
authors.initials: SD
authors.lastname: Reed
authors.forename: Louis C
authors.initials: LC
authors.lastname: Grothaus
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: La Croix
authors.forename: Larissa
authors.initials: L
authors.lastname: Nekhlyudov
authors.forename: Kelly
authors.initials: K
authors.lastname: Ehrlich
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D000529:Complementary Therapies; D004032:Diet; D015444:Exercise; D005194:Family Practice; D005260:Female; D006176:Gynecology; D015438:Health Behavior; D020249:Hormone Replacement Therapy / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009774:Obstetrics; D057240:Patient Preference; D010379:Peer Group; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D014481:United States
references.citation: Ann Intern Med. 1999 Apr 6;130(7):545-53
references.pmid: 10189323
references.citation: Obstet Gynecol. 2003 Dec;102(6):1233-9
references.pmid: 14662209
references.citation: Obstet Gynecol. 2004 Nov;104(5 Pt 1):1042-50
references.pmid: 15516400
references.citation: Menopause. 2018 Nov;25(11):1172-1179
references.pmid: 30358709
references.citation: Menopause. 2001 Sep-Oct;8(5):361-7
references.pmid: 11528363
references.citation: J Gen Intern Med. 2007 Sep;22(9):1311-6
references.pmid: 17634782
references.citation: Tidsskr Nor Laegeforen. 1998 Aug 20;118(19):2940-3
references.pmid: 9748831
references.citation: Ann Intern Med. 2004 Feb 3;140(3):184-8
references.pmid: 14757616
references.citation: Am J Obstet Gynecol. 1990 Nov;163(5 Pt 1):1438-44
references.pmid: 2240084
references.citation: Ann Intern Med. 2006 Dec 19;145(12):869-79
references.pmid: 17179056
references.citation: Obstet Gynecol. 1998 Oct;92(4 Pt 1):580-4
references.pmid: 9764632
references.citation: Maturitas. 2001 Jul 25;39(1):1-10
references.pmid: 11451615
references.citation: Obstet Gynecol. 2003 Dec;102(6):1225-32
references.pmid: 14662208
references.citation: Am J Obstet Gynecol. 2007 Feb;196(2):97-106
references.pmid: 17306645
references.citation: J Womens Health. 1998 Sep;7(7):879-84
references.pmid: 9785314
references.citation: Obstet Gynecol. 2005 May;105(5 Pt 1):953-61
references.pmid: 15863530
references.citation: Am J Med. 2005 Dec 19;118 Suppl 12B:98-108
references.pmid: 16414334
references.citation: Am J Epidemiol. 1997 Mar 15;145(6):536-45
references.pmid: 9063344
references.citation: Menopause. 2004 Nov-Dec;11(6 Pt 1):589-600
references.pmid: 15545786
references.citation: J Womens Health. 1997 Aug;6(4):459-65
references.pmid: 9279834
references.citation: Am J Epidemiol. 1997 Nov 15;146(10):870-80
references.pmid: 9384207
references.citation: Menopause. 2002 Sep-Oct;9(5):354-9
references.pmid: 12218724
references.citation: Menopause. 2004 Jan-Feb;11(1):89-97
references.pmid: 14716188
references.citation: Obstet Gynecol. 2002 Jul;100(1):18-25
references.pmid: 12100799
references.citation: Menopause. 2007 Jan-Feb;14(1):20-8
references.pmid: 17019376
references.citation: Am J Prev Med. 1997 Sep-Oct;13(5):358-65
references.pmid: 9315268
references.citation: Maturitas. 2007 Jan 20;56(1):30-7
references.pmid: 16797148
references.citation: J Gen Intern Med. 2005 Apr;20(4):350-6
references.pmid: 15857493