Judy Smith says she had five blissful years without hot flashes while participating in a landmark study of hormone supplements. But then she quit taking them after results showed the pills could cause more harm than good.
The symptoms returned for Smith — and many other participants in a new survey, suggesting that the pills might postpone but not prevent menopausal symptoms.
“You can’t necessarily expect to just skip that stage” by taking hormones, said Dr. Judith Ockene of the University of Massachusetts Medical School, the survey’s lead author.
The survey, which appears in Wednesday’s Journal of the American Medical Association, also found that menopause symptoms can last longer than many women thought. More than one-third of women who reported symptoms after stopping the study pills were in their 60s and 70s — at least 10 years older than the average age of menopause.
Researchers conducting the Women’s Health Initiative study said in July 2002 that estrogen-progestin pills sold as Prempro could increase risks for heart attacks, breast cancer and strokes.
Hormone supplements once were prescribed for millions of women for menopausal symptom relief and other aging ills. Use plummeted after the Women’s Health Initiative released its results.
The long-standing belief has been that symptoms subside a few years after women have their last period and that taking hormones might help women avoid symptoms, although strong scientific evidence about the duration has been lacking, Ockene said.
Researchers, she said, “would have assumed that 5½ years, which is the average length in this study, would have been enough time to see them not return.”
Symptoms postponed?
Smith, of Fitchburg, Mass., said she started having menopausal symptoms at age 49, with hot flashes so severe that they steamed up car windows. They disappeared during the study.
“Within a month they were back again. Not quite so bad, but I still wake up at night with a good one,” Smith, 73, said recently.
The original study involved 16,600 women aged 50 to 79 who were given Prempro or fake pills for up to about eight years. Smith was among 8,405 WHI participants surveyed by mail eight to 10 months after the study was halted.
Overall, 21 percent of Prempro users reported moderate to severe menopause symptoms afterward, compared with about 5 percent of women who’d taken fake pills. Ockene said those results suggest that many women on fake pills might have gone through natural menopause during the study, while for those on Prempro, the pills might have merely postponed the process. Also, not all women experience troublesome symptoms during menopause.
The study doesn’t address what happens when women stop taking hormones gradually, and a JAMA editorial says tapering the results might help alleviate symptoms.
Dr. Laura Corio, an obstetrician-gynecologist at New York’s Mount Sinai Medical Center, said the study confirms what she sees in patients who stop hormones — but doesn’t provide answers for those who want to know how long symptoms will last.
“I wish it was so clear cut. It really isn’t,” said Corio, who was not involved in the study.