In a Clinical Crossroads article published April 24, 2002,1 Deborah
Grady, MD, MPH, discussed the case of a 60-year-old woman with a family history
of breast cancer and a personal history of surgical menopause at age 40 who
had experienced severe hot flashes while trying to discontinue hormone therapy.
In her discussion, which was published after the Women’s Health
Initiative announcement regarding concerning trends in the study2 but
prior to publication of the study,3- 4 Dr
Grady discussed growing concerns about the potentially increased risk of breast
cancer risk and coronary events in users of hormone therapy based on the Heart
and Estrogen/Progestin Replacement Study, other published randomized trials,
and early reports from the Women’s Health Initiative. She suggested
that Mrs W try again to taper her estrogen, but over an extended period of
time. Dr Grady also suggested that Mrs W consider trying a selective serotonin
reuptake inhibitor to help with symptoms. However, she noted that estrogen
remains the most effective therapy for relief of vasomotor symptoms of menopause
and suggested that if Mrs W were unable to taper or discontinue the estrogen,
that Mrs W could continue the estrogen, but for symptom relief rather than
long-term prevention of disease.