Tapering versus cold turkey: symptoms versus successful discontinuation of menopausal hormone therapy.
Tapering versus cold turkey: symptoms versus successful discontinuation of menopausal hormone therapy.
复制标题
逐渐减少与冷火鸡：症状与成功停止更年期激素治疗。
DOI：
10.1097/gme.0b013e3181a057db
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Hess,Rachel
中科院分区：
文献类型：
--
作者：
Suffoletto,Jo-Anne;Hess,Rachel
Before the late 1990s, standard practice recommended that women be prescribed hormone therapy (HT; estrogen with or without progestin) for both primary and secondary prevention of cardiovascular disease. 1 In 1998, the Heart and Estrogen/Progestin Replacement Study2 reported an increase in cardiovascular events among women with a history of cardiovascular disease treated with conjugated equine estrogen and medroxyprogesterone acetate. The immediate response was that HT was inappropriate for secondary prevention but still retained a role of primary prevention of cardiovascular disease. 3 In 2002, the Women’s Health Initiative (WHI) investigators4 reported an increase in the composite outcome, including breast cancer and cardiovascular events, in women without preexisting cardiovascular disease randomly assigned to receive conjugated equine estrogen and medroxyprogesterone acetate. At this time, guidelines were revised to recommend against the routine use of HT for reasons other than treatment of menopausal symptoms and that treatment should continue for the shortest duration possible. 5, 6 When the WHI was stopped, participants abruptly discontinued HT. The investigators surveyed these women about their experience of symptoms after discontinuation of therapy. They found, among women with vasomotor symptoms at baseline, a higher percentage of women assigned to active treatment compared with placebo reported vasomotor symptoms upon discontinuation (55.5% vs 21.3%). 7 Five percent of the WHI participants elected to restart HT, with women assigned to active treatment more likely to restart than those assigned to placebo (7.6% vs 2.6%), usually for management of vasomotor symptoms. 7 Many women are able to stop HT without difficulty, but for a significant minority of women, discontinuing HT remains a challenge. 8 For clinicians and patients alike, these results have led to an interest in the most effective method of discontinuing HT. Currently, no evidence-based guidelines exist to help inform best clinical practice in this matter. Experts describe two approaches to HT discontinuation Bcold turkey [(abrupt, immediate cessation) versus tapering either by dose or number of days per week that HT is taken. 9 The duration of these tapers can range from several weeks to several months, and no optimal tapering regimen has yet been revealed in existing studies. Prior work looking at the optimal method for discontinuing HT has been inconclusive. A 2003 survey of women in a Northern California staff-based health maintenance organization found no difference in successful discontinuation based on stopping method (tapering vs abruptly). 8 Randomized controlled trials examining the method of discontinuation showed no difference in remaining off HT at 1 year10 or in recurrence of vasomotor symptoms11 with Bcold turkey [compared with tapering. In this issue of Menopause, Haskell et al12 report the results of their survey of a random sample of women veterans, selected from a Veteran’s Administration pharmacy database of 8,278 potentially eligible women who had discontinued HT either by stopping abruptly or by tapering. Of the total 836 women veterans who responded to the survey and had discontinued HT participants, 75% stopped cold turkey and 25% stopped by tapering. The authors compare the cold turkey and tapering groups with regard to demographics, participant’s specific health factors, and recurrence of menopausal symptoms after discontinuation of HT. No details about the tapering methods used by the participants are reported. Women who tapered, compared with those who quit cold turkey, were …
