1. Home>
2. Specialties>
3. Women's Health>
4. Summary and Comment

Gradual or Cold Turkey: When Stopping HT, Is One Better Than the Other?

Mode of HT discontinuation did not affect likelihood of hot-flash recurrence.

Since the publication of the Women's Health Initiative results (JW Womens Health May 2 2006), hormone therapy (HT) has been recommended only for women who have substantial symptoms at menopause — and then only for as long as necessary to alleviate symptoms. But is HT best discontinued abruptly or by tapering? To address this question, Swedish investigators conducted a multicenter trial of 81 women (median age, 59) who had used HT for 3 to 11 years. More than one third of participants used 1-mg estradiol plus 0.5-mg norethindrone acetate daily, 25% used estradiol plus medroxyprogesterone acetate, and 10% used tibolone or higher daily doses of estradiol.

Women were randomized to stop HT abruptly or to take their usual doses every other day for 4 weeks and then stop. Neither the number nor severity of hot flashes or the health-related quality of life (determined by questionnaire) differed during as long as 12 months of follow-up. Moreover, almost half the women (typically those with more-severe hot flashes) resumed HT by 1 year after discontinuation.

Comment: These data add to the growing body of evidence indicating that whether HT is stopped abruptly or gradually doesn't matter and that some women who experience recurrent severe vasomotor symptoms will restart HT. Whether these data are applicable to U.S. practice is unclear because prescribed estrogen doses in this country are sometimes lower and tibolone is not available. Furthermore, whether these conclusions apply equally to women who are taking HT to treat vasomotor symptoms and those who are using HT for other reasons is unclear.

— Robert W. Rebar, MD

Published in Journal Watch Women's Health February 4, 2010

Citation(s):

Lindh-Åstrand L et al. A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms. Menopause 2010 Jan/Feb; 17:72.

• Medline abstract (Free)

Reader Remarks:

Review and add to remarks on this article

• Stopping HRT
  Dr Ellen C G Grant, Kingston-upon-Thames, UK, 5 Feb 2010 1:34 PM EST
  As HRT increases breast cancer, the commonest cause of cancer and lung cancer , the commonest cause of cancer mortality,... [more]
• Begging the question: why stop HRT?
  Eliot Brinton, 5 Feb 2010 1:34 PM EST
  The question not addressed in the study, nor by JW is, why stop HRT? Yes, the guidance post WHI is... [more]
• ht stopping method.
  k.d. kapasi, 8 Feb 2010 3:21 PM EST
  if confounding factors are taken care of the study should appply to all populations. anyway it is worth evaluating as... [more]
• hrt
  John B Girard, ob-gyn, 8 Feb 2010 3:21 PM EST
  Sadly, maybe tragically, the WHI certainly did not answer the HRT issue, and even the follow up on the treated... [more]
• "gradual?"
  R Hoca, 8 Feb 2010 3:21 PM EST
  Certainly, we cannot consider a taper over one month to be considered "gradual"! When looking at hot flush reduction when... [more]
• tapered?
  Teresa Charniga, 8 Feb 2010 3:23 PM EST
  I don't consider 4 weeks to be much of a taper. I usu taper over several months.
• Ht to be tapered or abruptly withdrawn
  Gunnbjorg Lavoll, medical office, 9 Feb 2010 5:37 PM EST
  It makes the recommendations less complicated when there are fewer choices.
• HT Should be continued if started in window of oppotunity
  maninder ahuja, faridabad, 16 Feb 2010 8:00 AM EST
  if HT started early then can be continued for five years according to Indian menopause Association. and window of opportunity... [more]
• Tapering HT
  JL Titus, 16 Feb 2010 8:00 AM EST
  I agree that one month is not a "taper". I usually taper off over 1-2 years and have found this... [more]
• Taperig HT
  Rochelle Y. Odell, permanently disabled, 8 Mar 2010 2:07 PM EST
  I was working as an ICU Nurse Tech when the hot flashes hit, and was placed on Ortho-est, at a... [more]
• Tapering or Cold Turkey on HRT
  Rochelle Y. Odell, Former EMT ii and ICU Nurse Tech before CRPS/RSD ended my career, 12 Apr 2011 11:30 AM EST
  Specialty: Other Specialty
  I was very interested in all the remarks my questions brought up, and feel there does need to be further... [more]

2011 Top Stories