Symptom Experience After Discontinuing Use of Estrogen Plus Progestin

July 2005

Findings Summary

In July 2002, women in the WHI Estrogen Plus Progestin (E+P) trial were asked to stop their study pills because the overall risks of taking combined estrogen and progestin were greater than the benefits. Soon after, medical guidelines changed to say that menopausal hormone therapy should be used mainly for moderate to severe menopausal symptoms, like hot flashes and night sweats. These new guidelines also said women should take hormones for the shortest time and at the lowest dose possible. Throughout the world, women who were taking hormone therapy began to ask their health care providers about stopping.
Because there was almost no information about what happens when women stop hormones, WHI scientists asked the E+P participants who had just stopped their study pills to fill out a survey about their symptoms and decisions about hormones since stopping. From March through August 2003, surveys were mailed out to over 9,000 E+P participants who stopped their study pills 8 to 12 months earlier after taking them for an average of almost 6 years. Nearly 90% of these women mailed back the surveys.
All of the women knew if they had been in the active hormone or inactive placebo pill group when they filled out the survey, but their data answered some key questions about stopping hormones. E+P participants who stopped their study pills before July 2002 were not sent the survey because they stopped at different times and for many other reasons. These women may have had different experiences when they stopped study pills.
The data analyses focused on symptoms such as hot flashes or night sweats, vaginal dryness, and pain or stiffness. Findings were published in the July 13, 2005 issue of the Journal of the American Medical Association (JAMA), including:
  • Women who had menopausal symptoms when they joined the WHI, regardless of their age, were more likely to have these symptoms after stopping study pills than women who did not have symptoms.
  • After stopping their study pills, women in the active hormone group reported more symptoms than women in the placebo pill group.
  • Women who took hormones before they joined the WHI were more likely to have hot flashes or night sweats after stopping than women who did not take hormones.
  • Women tried to manage their symptoms in different ways, including drinking more fluids, exercising, and talking with a health care provider. Most women found these efforts helpful.
  • Compared with women who tried other strategies to help with symptoms, fewer women who tried herbal or natural hormones said they helped.
  • Very few women started prescription hormones after stopping their study pills.
These findings answer some questions about what happens when hormone therapy is stopped. Women who are thinking about taking hormones for menopausal symptoms should keep in mind that they may have these symptoms again after stopping. More research is needed about how long hormones need to be taken. Women also need more answers about things they can do, other than take hormones, to treat their menopausal symptoms.