Factors associated with successful discontinuation of hormone therapy.
BACKGROUND
Careful management of symptoms, particularly sleep and mood disturbances, may assist women in discontinuing hormone therapy (HT). We sought to describe characteristics associated with successful HT cessation in women who attempted to discontinue estrogen pills/patches with or without progestin.


METHODS
We invited 2,328 women, aged 45-70, enrolled January 1, 2005, to May 31, 2006, at Group Health in Washington State and Harvard Vanguard Medical Associates in Massachusetts, to participate in a telephone survey about HT practices. For the sample, we selected 2,090 women with estrogen dispensings (pharmacy data) during the study period, 200 women without HT dispensing after January 2005, and 240 women with no estrogen dispensings; 1,358 (58.3%) completed the survey. These analyses are based on survey responses.


RESULTS
Among 802 women who attempted HT discontinuation, the mean age was 50 years, 93% were postmenopausal, 90% were white, 30% had had a hysterectomy, and 75% experienced hot flashes after discontinuation. Those who did not succeed had greater trouble sleeping (74% vs. 57%) and mood disturbances (51% vs. 34%) than those who succeeded. In multivariable analyses, factors associated with successful discontinuation included doctor advice (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.68-4.08), lack of symptom improvement (OR 4.21, CI 1.50-12.17), vaginal bleeding (OR 5.96, CI 1.44-24.6), and learning to cope with symptoms (OR 3.36, CI 2.21-5.11). Factors associated with unsuccessful HT discontinuation included trouble sleeping (OR 0.40, CI 0.26-0.61) and mood swings or depression (OR 0.63, CI 0.42-0.92).


CONCLUSIONS
Doctor advice is strongly associated with successful HT discontinuation. Symptom management, particularly sleep and mood disturbances, may help women discontinue HT.
1 Group Health Research Institute , Seattle, Washington.
Katherine M
KM
Newton
Susan D
SD
Reed
Larissa
L
Nekhyludov
Louis C
LC
Grothaus
Evette J
EJ
Ludman
Kelly
K
Ehrlich
Andrea Z
AZ
LaCroix
D000368:Aged; D016022:Case-Control Studies; D015914:Estrogen Replacement Therapy / Q000379:methods* / Q000706:statistics & numerical data; D004967:Estrogens / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006306:Health Surveys; D019584:Hot Flashes; D006801:Humans; D007407:Interviews as Topic; D008404:Massachusetts; D055118:Medication Adherence; D008593:Menopause / Q000187:drug effects* / Q000502:physiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011372:Progestins / Q000008:administration & dosage* / Q000009:adverse effects; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D004967:Estrogens; D011372:Progestins