Search:
Menopause Live - IMS Updates
InFocus

Date of release: 28 November, 2011

Stopping HRT: were women ill advised?


The aim of a recently published study by Cummings and colleagues was to survey the views of women who stopped hormone replacement therapy (HRT) after 2002, including those who later restarted [1]. A questionnaire survey was carried out on the UK-based menopause website www.menopausematters.co.uk, evaluating how women were influenced by HRT advice. The main outcome measures were the answers to questions regarding stopping/restarting HRT in response to the advice in the early 2000s and advice given today. A total of 1100 responses were obtained. Of those who made the decision to stop HRT themselves, 56.4% (n = 425/754) said that they were influenced by the media. In those who would potentially most benefit from HRT, 72.8% (n = 220/302) stopped without medical advice. Overall, women aged under 50 years were significantly more likely to stop HRT themselves than women over 50 years (p < 0.001). In women in whom symptoms returned, 37.5% (n = 362/966) said these affected their ability to work, 45.1% (n = 436) had problems with decision making, 53.6% (n = 518) admitted to relationships being negatively affected and 29.2% (n = 286) said that symptoms affected their social relationships. Overall, 46.5% of women (n = 485/1044) would not have stopped HRT given the current understanding of risk. Compared with women over 50, significantly more women under the age of 50 said that they would not have previously stopped their HRT based on their current understanding of risk (p < 0.001).

Comment

Since publication of the results of the Women’s Health Initiative (WHI) trial in 2002 [2] and the Million Women Study in 2003 [3], there has been much confusion around the use of HRT, with media reporting frequently emphasizing the risks and ignoring the benefits of HRT. As a result, many women world-wide either chose to, or were advised to stop using their HRT. Although for some there may have been no recurrence of symptoms from stopping, it is unclear how many women have suffered from recurrence of menopausal symptoms, which may have adversely affected their quality of life or indeed have had a detrimental effect on bone mass or cardiovascular health [4]. A post-WHI European survey indicated that two-thirds of menopausal women were suffering from at least one severe symptom and, although most felt that menopause should be treated, only 22% were using a recognised preparation [5]. The aftermath of the publication of the Million Women Study and the re-evaluation of the data emerging from the WHI studies have shown that the messages that emerged from them were confusing and flawed. 
 
The findings of this study suggest that the negative impact of published research and its reporting from the early 2000s are being mitigated by current press coverage. Media reports appear to have influenced younger women more than older women. This is worrying, as it is particularly important that young women with early menopause continue HRT at least until the average age of the menopause, to preserve quality of life and to prevent long-term complications such as osteoporosis, cardiovascular disease and cognitive impairment. The study highlights the responsibility on the shoulders of researchers and the media with regards to the potential impact their publications can have on vulnerable people. 
 
The limitations of the study are that this was a relatively small questionnaire survey. The data could potentially have been biased by the type of women using the Menopause Matters website and by the type of women choosing to answer the survey, i.e. those with greater concerns would have been more likely to have taken the time to respond to the survey. Nevertheless, bias was eliminated as much as possible by not petitioning women to respond to the survey and by not offering incentives. Also, each questionnaire could only be completed once per computer. Internet provider addresses were checked for duplicates and none were found [6].
 
An attempt was made by Menopause Matters to expand the survey by inviting participants through Our Menopause World, a global electronic menopause news service of the International Menopause Society, to fill in a questionnaire on the Menopause Matters website. The response to this was surprisingly low compared to previous UK national surveys by Menopause Matters which had had an excellent response [7]. It suggests that international surveys are better conducted by the regional or national affiliates themselves as they are likely to be sensitive to local issues, with the IMS providing a central coordinating role. Clearly, more data are desirable, not only on HRT usage, but also on the incidence of clinical outcomes, to determine precisely how much damage has been done by the often unnecessary discontinuation of HRT by many women following WHI and the Million Women Study.

Comentario

Nick Panay
Queen Charlottes & Chelsea and Chelsea & Westminster Hospitals, London, UK

    References

  1. Cumming GP, Currie HD, Panay N, Moncur R, Lee AJ. Stopping hormone replacement therapy: were women ill advised? Menopause Int 2011;17:82-7.
    http://www.ncbi.nlm.nih.gov/pubmed/21903711

  2. Writing Group for the Womens Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Womens Health Initiative randomized controlled trial. JAMA 2002;288:321-33.
    http://www.ncbi.nlm.nih.gov/pubmed/12117397

  3. Beral V; Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 2003;362:419-27.
    http://www.ncbi.nlm.nih.gov/pubmed/12927427

  4. Ockene JK, Barad DH, Cochrane BB, et al. Symptom experience after discontinuing use of estrogen plus progestin. JAMA 2005;294:183-93.
    http://www.ncbi.nlm.nih.gov/pubmed/16014592

  5. Genazzani AR, Schneider HP, Panay N, Nijland EA. The European Menopause Survey: womens perceptions on the menopause and postmenopausal hormone therapy. Gynecol Endocrinol 2005;22:369-75.
    http://www.ncbi.nlm.nih.gov/pubmed/16864146

  6. Eysenbach G. Improving the quality of web surveys: the Checklist for Reporting Results of Internet E-surveys (CHERRIES). J Med Internet Res 2004;6:e34.
    http://www.ncbi.nlm.nih.gov/pubmed/15471760

  7. Cumming GP, Currie HD, Moncur R, Lee AJ. Web-based survey on the effect of menopause on a womens libido in a computer literate population. Menopause Int 2009;15:8-12.
    http://www.ncbi.nlm.nih.gov/pubmed/19237616