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Hormone therapy discontinuation: physician practices after the Women's Health Initiative

Newton, Katherine M. PhD1,2; Reed, Susan D. MD, MPH2,3; Grothaus, Louis C. MS1; La Croix, Andrea Z. PhD1,2,4; Nekhlyudov, Larissa MD, MPH5; Ehrlich, Kelly MS1; Ludman, Evette J. PhD1

doi: 10.1097/gme.0b013e3181d2ce57
Articles

Objective: No guidelines or randomized trials address best practices for hormone therapy (HT) discontinuation.

Methods: We conducted a survey study to explore HT discontinuation practices at Group Health and Harvard Vanguard, large integrated health systems in the Northwest and Northeast United States, focusing on differences between specialties and study site.

Results: The response rate to the written questionnaire (mailed between December 2005 and May 2006) was 78.5% (736/928); this article reports the results for 483 eligible physicians. To discontinue oral HT, most physicians (91%) advised tapering, not immediate cessation (8%), and most (60%) suggested decreasing both dose and days per week. Almost 60% of physicians reported no experience with tapering patches. Harvard Vanguard physicians were more likely than Group Health physicians to encourage discontinuing HT and less likely to recommend resuming HT when a woman's symptoms returned after discontinuing HT. Physicians were most strongly influenced by their own experience (48%), advice from colleagues (25%), and the woman's preference (19%) when choosing a discontinuation strategy; only 2% relied on research evidence. Physicians endorsed various approaches to manage symptoms after HT discontinuation, most often behavioral changes (44%) and increased exercise (37%), and these approaches were more often endorsed by Harvard Vanguard physicians and obstetrician/gynecologists than Group Health physicians or family practitioners or internists.

Conclusions: Two health plans in the Northwestern and Northeastern United States have no standard protocol for HT discontinuation. Physicians customized approaches, influenced by their location, colleagues, and specialty. Research is needed to guide approaches to HT discontinuation.

Most physicians advised tapering dose and days per week to discontinue menopausal hormone therapy, and they most often suggest behavioral changes and increased exercise to assist women in coping with symptoms if they return. Evidence is needed to support the efficacy of these recommendations.

From the 1Group Health Research Institute, Seattle, WA; 2Department of Epidemiology and 3Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, WA; 4Fred Hutchinson Cancer Research Institute, Seattle, WA; and 5Department of Population Medicine, Harvard Medical School, and Division of Internal Medicine, Harvard Vanguard Medical Associates, Boston, MA.

Received July 28, 2009; revised and accepted January 4, 2010.

Funding/support: This work was supported by the National Institutes of Health through National Institute on Aging grant AG-022578.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Katherine M. Newton, PhD, External Research, Group Health Research Institute, 1730 Minor Ave., Ste 1600, Seattle, WA 98101. E-mail: newton.k@ghc.org

©2010The North American Menopause Society