Health Outcomes After Stopping Conjugated Equine Estrogens Among Postmenopausal Women With Prior Hysterectomy: A Randomized Controlled Trial

LaCroix, Andrea Z.; Chlebowski, Rowan T.; Manson, JoAnn E.; Aragaki, Aaron K.; Johnson, Karen C.; Martin, Lisa W.; Margolis, Karen L.; Stefanick, Marcia L.; Brzyski, Robert G.; Curb, J. David; Howard, Barbara V.; Lewis, Cora E.; Wactawski‐Wende, Jean

doi:10.1097/ogx.0b013e3182338d18

Cited by 96 publications

(142 citation statements)

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“…Additionally, following the initial report of results from the WHI, a significant decrease in breast cancer incidence in the U.S. was noted, which was hypothesized to be related to a decline in HRT intake resulting from awareness of the WHI findings. On the other hand, long-term follow-up from that study demonstrated that estrogen replacement therapy alone did not increase the risk for breast cancer recurrence [30]. However, data from a meta-analysis of 16 studies evaluating the use of estrogen therapy alone demonstrated that long-term estrogen replacement therapy was associated with a 30% higher relative risk for breast cancer [31,32].…”

Section: Estrogen Replacement Therapiesmentioning

confidence: 99%

Hot Flashes: A Review of Pathophysiology and Treatment Modalities

2011

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Section: Estrogen Replacement Therapiesmentioning

confidence: 99%

Hot Flashes: A Review of Pathophysiology and Treatment Modalities

2011

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“…(28) With discontinuation of HT, efficacy against hip fracture is lost after 3 to 5 years (compared with on-treatment values). (29)(30)(31) This loss of fracture protection is paralleled by a decrease in BMD and an increase in BTM levels that temporarily exceed baseline (Table 2; Fig. 1A).…”

Section: Hormone Therapymentioning

confidence: 96%

Postmenopausal osteoporosis treatment with antiresorptives: Effects of discontinuation or long-term continuation on bone turnover and fracture risk—a perspective

Boonen¹,

Ferrari²,

Miller³

et al. 2012

Journal of Bone and Mineral Research

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Osteoporosis may be a lifelong condition. Robust data regarding the efficacy and safety of both long-term osteoporosis therapy and therapy discontinuation are therefore important. A paucity of clinical trial data regarding the long-term antifracture efficacy of osteoporosis therapies necessitates the use of surrogate endpoints in discussions surrounding long-term use and/or discontinuation. Long-term treatment (beyond 3-4 years) may produce further increases in bone mineral density (BMD) or BMD stability, depending on the specific treatment and the skeletal site. Bisphosphonates, when discontinued, are associated with a prolonged reduction in bone turnover markers (BTMs), with a very gradual increase to pretreatment levels within 3 to 60 months of treatment cessation, depending on the bisphosphonate used and the prior duration of therapy. In contrast, with nonbisphosphonate antiresorptive agents, such as estrogen and denosumab, BTMs rebound to above pretreatment values within months of discontinuation. The pattern of BTM change is generally mirrored by a more or less rapid decrease in BMD. Although the prolonged effect of some bisphosphonates on BTMs and BMD may contribute to residual benefit on bone strength, it may also raise safety concerns. Adequately powered postdiscontinuation fracture studies and conclusive evidence on maintenance or loss of fracture benefit is lacking for bisphosphonates. Similarly, the effects of rapid reversal of bone turnover upon discontinuation of denosumab on fracture risk remain unknown. Ideally, studies evaluating the effects of long-term treatment and treatment discontinuation should be designed to provide head-to-head ''offset'' data between bisphosphonates and nonbisphosphonate antiresorptive agents. In the absence of this, a clinical recommendation for physicians may be to periodically assess the benefits/risks of continuation versus discontinuation versus alternative management strategies. ß

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“…15 Influential advice to women is likely to be provider dependent and increasingly personalized. For example, long-term followup results from the WHI Estrogen Plus Progestin 16 and Estrogen Alone studies 17 show that risk is highly related to initiation age and estrogen use with or without progestin. Providers who understand these subtle findings can better assist with informed decision making about HT initiation and discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Successful Discontinuation of Hormone Therapy

Newton

Reed

Nekhyludov

et al. 2014

Journal of Women's Health

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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. 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, vaginal bleeding (OR 5.96,, 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,. Conclusions: Doctor advice is strongly associated with successful HT discontinuation. Symptom management, particularly sleep and mood disturbances, may help women discontinue HT.

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Health Outcomes After Stopping Conjugated Equine Estrogens Among Postmenopausal Women With Prior Hysterectomy: A Randomized Controlled Trial

Cited by 96 publications

References 0 publications

Hot Flashes: A Review of Pathophysiology and Treatment Modalities

Hot Flashes: A Review of Pathophysiology and Treatment Modalities

Postmenopausal osteoporosis treatment with antiresorptives: Effects of discontinuation or long-term continuation on bone turnover and fracture risk—a perspective

Factors Associated with Successful Discontinuation of Hormone Therapy

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