Coping After Hrt

When the National Institutes of Health halted its trial of Prempro--the combination hormone therapy--in July, citing long-term risk factors, Susan Carroll threw away her drugs and hoped she'd escaped any harm. Then she began to sweat. Life, says Carroll, 52, has been "hell." Hot flashes burn through her body. Sleeping? Forget about it. "I can't believe going through menopause naturally would be like this," she says. "I am about to go out of my mind."

She's not the only one. The NIH trial reported critical long-term data: the slight increased risks (heart attack, stroke and breast cancer) of taking combination therapy outweighed the benefits (bone protection and lower colon-cancer rates). But what the study did not address were the short-term benefits of hormone-replacement therapy, such as suppression of hot flashes and improved sleep, which Carroll had been enjoying for years. Nor could investigators predict what would happen to the thousands of other women who also stopped taking their medication abruptly. Since July, sales of Prempro, the leading combination of estrogen and progestin, have plummeted 40 percent. Last week, while NIH investigators, doctors and health agencies convened in Washington to take a closer look at the trial data, women across the country were wondering how to cope. "I'm getting women calling up and saying, 'I can't function, I can't sleep, I can't think straight and I can't have sex'," says Dr. Lauren Streicher, an Ob-Gyn at Chicago's Northwestern Memorial Hospital.

Not everyone who goes off HRT has such trouble. Women in their late 50s and beyond may have aged through menopause while on the drugs, and thus be relatively symptom-free when they go off. Younger women who quit cold turkey may be hit hardest. Susan Hendrix, one of the trial's principal investigators, says she suspects that in some cases HRT withdrawal could be even more difficult than managing the original symptoms of menopause. "We have no way of telling if that's true," she says, "but it's a very-often-described phenomenon."

There are ways to help ease the transition. Tapering off the drugs slowly helps mitigate symptoms. Antidepressants can control the sweats, though they're not without side effects. And then there are the lifestyle changes: quitting smoking, using relaxation techniques and eliminating spicy foods and caffeine. Some women, though, say they may return to hormones. Streicher says about one third of her patients who went off are asking if they can go back on and, in some cases, the answer is yes. If a woman's symptoms are disabling and she has no serious risk factors for heart disease or breast cancer, short-term--and perhaps lower-dose--therapy may be appropriate, says Streicher.

The consensus now is that nobody should take HRT for long-term protection against chronic disease. But when it comes to short-term relief, it's up to women and their doctors to weigh individual risks and symptoms. "Everybody agrees we need more research," says Dr. Vivian Pinn, head of the NIH's Office of Research on Women's Health. "It's taking time, but more answers are coming." For millions of women, those answers can't come soon enough.