Counseling patients who elect to discontinue hormone therapy

Following the reports of the Heart and Estrogen/Progestin Replacement (HERS) Trial and the Women's Health Initiative (WHI), many women abruptly discontinued their hormone therapy. This withdrawal of estrogen causes physiological changes, some changes which are short-term and obvious (i.e., hot flashes, night sweats) and other changes that are more subtle and lead to long-term problems (i.e., loss of bone density, increased risk of fracture). Health care providers need to be prepared to discuss alternative therapies available to women who have recently stopped estrogen therapy. Practitioners today have many more, and better, therapeutic choices to prevent osteoporosis than ever before. Counseling patients on which treatment options: raloxifene, bisphosphonate, calcitonin, or PTH are most appropriate for their situation is important to long-term compliance and a satisfactory reduction in fracture risk.