Although most women in the estrogen-alone (conjugated equine estrogen, CEE) arm of the Women’s Health Initiative (WHI) did not suffer vasomotor symptoms, the newly published study  followed those women ([i]n[/i] = 3496) during the active phase and then after discontinuation of trial medication at a mean 7.4 ± 1.1 years from baseline. The mean age at trial closure was 73 years. Approximately one-third of participants reported at least one moderate to severe symptom at baseline. Fewer symptoms were reported with increasing age, except joint pain/stiffness, which was similar among age groups. At 1 year, hot flushes, night sweats and vaginal dryness were reduced by CEE, whereas breast tenderness was increased. Breast tenderness was also significantly higher in the CEE group at trial closure. After stopping, vasomotor symptoms were reported by significantly more women who had reported symptoms at baseline, compared with those who had not, and by significantly more participants assigned to CEE (9.8%) vs. placebo (3.2%); however, among women with no moderate or severe symptoms at baseline, more than five times as many reported hot flushes after stopping CEE (7.2%) vs. placebo (1.5%). The concluding sentences of the article’s Abstract were as follows: ‘CEE significantly reduced vasomotor symptoms and vaginal dryness in women with baseline symptoms but increased breast tenderness. The likelihood of experiencing symptoms was significantly higher after stopping CEE than placebo regardless of baseline symptom status. These potential effects should be considered before initiating CEE to relieve menopausal symptoms.’
Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel
Brunner RL, Aragaki A, Barnabei V, et al. Menopausal symptom experience before and after stopping estrogen therapy in the Womens Health Initiative randomized, placebo-controlled trial. Menopause 2010 June 2. Epub ahead of print.