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Menopausal Hormone Therapy: A New Debate

Many Older Women Are Restarting Therapy After Menopausal Symptoms Return

Unexpected Symptoms continued...

"Menopause was a breeze for me," she tells WebMD. "I had no symptoms whatsoever when I entered menopause and only a few noticeable symptoms later on."

Turner began hormone therapy when she was recruited for the WHI trial at age 60. Many postmenopausal women like her were included in the study, which was designed to determine if hormone therapy could help prevent heart disease, osteoporosis, and other conditions related to aging.

Linda Churchill, who is project coordinator for the WHI trial in Worcester, Mass., tells WebMD that it was common for older women who had no menopausal symptoms when they started the treatment to have them when they stopped it.

"It is like the clock was pushed back for them," she says. "We found that it usually took about six months for women to stop having hot flashes and other symptoms when they came off hormone therapy, but some women kept having them."

Surprisingly, a large percentage of the WHI participants who didn't even take hormones, but had instead taken a placebo pill, also developed some troubling symptoms when they stopped treatment.

Is It Menopause?

The finding in a new study that 40% of placebo users had moderate to severe menopausal symptoms raises questions about the basis of some of these symptoms, says researcher Diana Petitti, MD, of Kaiser Permanente Southern California.

"Which of these are true consequences of cessation of estrogen production by the ovary?" Petitti wrote in an editorial, published in the July 13 issue of The Journal of the American Medical Association.

An expert panel convened by the National Institutes of Health recently concluded that many symptoms commonly attributed to menopause probably have nothing to do with ovarian aging. They include mood swings and depression, anxiety and irritability, forgetfulness and other cognitive problems, tiredness, and joint stiffness.

Petitti tells WebMD that a better understanding of female aging is needed to effectively treat its symptoms.

She says hormone therapy may be an appropriate choice for some menopause-related symptoms, such as hot flashes, night sweats, and vaginal dryness, but it is not the only choice.

"If we really understood what is happening as women age instead of blaming it all on menopause, women would be much better off," she says. "Clearly, there is much more going on."


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