Author Affiliation: Dr Grady is Professor of Epidemiology and Medicine, Department of Epidemiology, University of California, San Francisco.
Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
DR REYNOLDS: Mrs W is a 60-year-old white woman
who is trying to discontinue her estrogen therapy. She lives alone near Boston
and teaches middle school. Her 29-year-old son lives in another state. She
has managed care insurance.
At the age of 40, Mrs W underwent hysterectomy and bilateral salpingo-oophorectomy
to treat refractory endometriosis. After several days of severe flushes, sweats,
and depression, she began taking conjugated estrogen, 0.625 mg/d. With that
therapy she has felt well for the past 2 decades. Over the past few years,
she became increasingly concerned about her family history of breast cancer
and the health risks of postmenopausal hormone replacement therapy (HRT) after
reading about it in the lay press. Mrs W asked her former physician about
these risks, and he encouraged her to continue treatment. At times, she discontinued
the estrogen on her own, but disabling hot flushes ensued and she restarted
treatment each time.
Grady D. A 60-Year-Old Woman Trying to Discontinue Hormone Replacement Therapy. JAMA. 2002;287(16):2130-2137. doi:10.1001/jama.287.16.2130