Discontinuing postmenopausal hormone therapy: an observational study of tapering versus quitting cold turkey: is there a difference in recurrence of menopausal symptoms?

Objective: Because no current evidence-based guidelines for postmenopausal hormone therapy (HT) discontinuation strategies exist, we compared female veterans who tapered HT to those who stopped abruptly with regard to patient-specific health factors and recurrence of menopausal symptoms. Methods: We identified female veterans who used combined estrogen/medroxyprogesterone HT in 2001 using the VA Pharmacy Benefits Management database. We then randomly sorted and selected 4,000 women for a mailed invitation to participate in a HT survey. Women who agreed to participate were mailed the National Women Veterans Hormone Replacement Survey. Results: Of 836 participants who discontinued HT, 75% stopped cold turkey and 25% tapered. In bivariate analysis, taperers were more likely to report higher incomes, less smoking, and more use of alternatives such as vitamin E, other dietary supplements, and exercise or yoga for menopausal symptoms. They also more frequently reported discussions of menopausal symptoms with providers and used HT for menopausal symptoms and had longer median years of HT (P <= 0.05 for each comparison). In multivariate analysis, tapering was significantly associated with younger age (odds ratio [OR], 0.97; 95% CI, 0.94-0.99), initiating HT for menopausal symptoms (OR, 1.66; 95% CI, 1.06-2.62), moderate (OR, 1.67; 95% CI, 1.11-2.51) or prolonged (OR, 2.86; 95% CI, 1.76-4.65) years of HT use, use of vitamin E (OR, 1.58; 95% Cl, 1.02-2.44), use of yoga (OR, 2.41; 95% Cl, 1.05-5.55), and higher income (OR for income <$20.000/y, 0.65; 95% Cl, 0.46-0.92). Separately, tapering HT was significantly associated with lower menopausal symptom scores after discontinuation (beta = -0.58 +/- 0.21, P = 0.01). However, tapering HT also had a significant association with resumption of hormones at a later date (OR, 2.06; 95% CI, 1.20-3.52). Conclusions: Tapering HT may lessen recurrence of menopausal symptoms after discontinuation, but some women may remain inclined to return to HT. Separately, in the Department of Veterans Affairs Healthcare System, female veterans resuming HT need providers who can discuss HT options.