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A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
Umeå University.
Karolinska Institutet.
Uppsala University.
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2010 (English)In: Menopause (New York, N.Y.), ISSN 1530-0374, Vol. 17, no 1, 72-79 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:: The aim of this study was to investigate whether tapering down of combined estrogen plus progestogen therapy (EPT) reduced the recurrence of hot flashes and resumption of therapy compared with abrupt discontinuation. A secondary aim was to evaluate whether health-related quality of life (HRQoL) was affected after discontinuation of EPT and to investigate the possible factors predicting resumption of EPT.

METHODS:: Eighty-one postmenopausal women undergoing EPT because of hot flashes were randomized to tapering down or abrupt discontinuation of EPT. Vasomotor symptoms were recorded in self-registered diaries, and resumption of hormone therapy (HT) was asked for at every follow-up. The Psychological General Well-being Index was used to assess HRQoL.

RESULTS:: Neither the number nor the severity of hot flashes or HRQoL or frequency of resumption of HT differed between the two modes of discontinuation of EPT during up to 12 months of follow-up. About every other woman had resumed HT within 1 year. Women who resumed HT after 4 or 12 months reported more deteriorated HRQoL and more severe hot flashes after discontinuation of therapy than did women who did not resume HT.

CONCLUSIONS:: Women who initiate EPT because of hot flashes may experience recurrence of vasomotor symptoms and impaired HRQoL after discontinuation of EPT regardless of the discontinuation method used, abrupt or taper down. Because, in addition to severity of flashes, decreased well-being was the main predictor of the risk to resume HT, it seems important to also discuss quality of life in parallel with efforts to discontinue HT.

Place, publisher, year, edition, pages
2010. Vol. 17, no 1, 72-79 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-20552DOI: 10.1097/gme.0b013e3181b397c7PubMedID: 19675505OAI: diva2:235020
This is a non-final version of an article published in final form in: Lotta Lindh-Åstrand, Marie Bixo, Angelica Hirschberg, Inger Sundström-Poromaa and Mats Hammar, A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms., 2009, Menopause (New York, N.Y.). Copyright: Raven Press, Ltd. Available from: 2009-09-11 Created: 2009-09-11 Last updated: 2011-01-19Bibliographically approved
In thesis
1. Women's knowledge, attitudes, and management of the menopausal transition
Open this publication in new window or tab >>Women's knowledge, attitudes, and management of the menopausal transition
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Hormone therapy (HT) has been considered as a safe treatment for menopausal symptoms. Use of HT increased dramatically in the 1980s and 1990s. Results from large randomized clinical trials (RCT) could, around the turn of the century, however not find evidence for long-term benefits with HT. These results attracted great attention from media and the scientific community leading to changed treatment guidelines and decreased use of HT.

Aim: The overall aim of this thesis was to explore Swedish women’s conceptions, knowledge, management, and attitudes regarding the menopausal transition and HT.

Material and methods: To explore and describe women’s conceptions of the menopausal transition women seeking medical advice due to climacteric symptoms were interviewed (n=20) and their statements were analyzed with a qualitative method (paper I). In 1999 (n=1760) and 2003 (n=1733) attitudes to (paper II) and knowledge of (paper III) the menopausal transition and HT among 53- and 54 year old women were investigated with a cross-sectional design using postal questionnaires. We also analyzed if attitudes differed before and after new scientific findings were published on risks and benefits of HT and if knowledge differed between educational levels. Since many women try to abandon use of HT a RCT was performed to study the effect of two different methods to discontinue HT, on recurrence of hot flushes, resumption of HT and on health related quality of life (HRQoL). Women (n=87) with vasomotor symptoms before initiating HT participated.

Results: We found that the majority of the middle aged women in our study viewed the menopausal transition as a natural process the nature of which is affected by both hormonal changes and by ageing. Each woman seems to experience a set of psychological and physical symptoms that are in some sense unique to her experience. Women’s answers to the questions about HT demonstrate that attitudes towards HT held by women going through menopause have changed rather dramatically between 1999 and 2003. These changes probably reflect the influence on the women of media reports based on research that identified risks associated with HT that had not been identified before 1998.

Women’s knowledge of the effects of HT seems to be unsatisfactory from a clinical perspective. No differences in hot flush frequency and resumption of HT were found between the women randomized to two different modes of discontinuation of HT. Almost 50 % of the women restarted HT within one year after discontinuation. Deteriorated wellbeing and severity of hot flushes were important predicting factors for resumption of HT.

Conclusion: It is important to be aware of the individual woman’s conceptions and attitudes about and knowledge of the menopausal transition and HT to be able to individualize the counselling situation. Women who initiate HT due to hot flushes may experience recurrence of vasomotor symptoms and deteriorated HRQoL after discontinuation. A great proportion of them may resume HT. At present knowledge of possible advantages for the taper-down method when discontinuing HT is still lacking.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 67 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1153
Menopause, hormone therapy, knowledge, attitudes, conceptions, management/treatment, climacteric symptoms, hot flushes
National Category
Obstetrics, Gynecology and Reproductive Medicine
urn:nbn:se:liu:diva-21896 (URN)978-91-7393-531-9 (ISBN)
Public defence
2009-10-30, Aulan, Hälsans Hus, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Available from: 2009-10-12 Created: 2009-10-06 Last updated: 2009-10-12Bibliographically approved

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Lindh-Åstrand, LottaHammar, Mats
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Obstetrics and gynecologyFaculty of Health SciencesDepartment of Gynecology and Obstetrics in Linköping
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