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Hormone replacement therapy use in US continues to decline

Robin Wulffson MD's picture
hormone replacement therapy, HRT, menopause, estrogen patch, risks

According to a new study, the use of hormone replacement therapy (HRT) to relieve symptoms of the menopause has continued to decline over the last decade. Researchers affiliated with the University of Vermont (Burlington, Vermont) and the National Cancer Institute (Bethesda, Maryland) published their findings in the September 2012 issue of the journal Obstetrics & Gynecology.

The researchers noted that short-term declines in postmenopausal hormone use were observed after the Women’s Health Initiative trial results were released in 2002. Unfavorable results from a large randomized trial of combined estrogen plus progestin, revealed that on average the health risks of this type of postmenopausal hormone use exceeded the benefits. The purpose of the new study was to perform a closer examination of the changing patterns of postmenopausal use in the United States. In particular, the authors attempted to determine whether the short-term decline in postmenopausal hormone use after the publication of the Women’s Health Initiative results has been sustained and whether the prevalence of estrogen-only hormone use and estrogen plus progestin hormone use have changed in a similar fashion. To accomplish these objectives and to provide current estimates of hormone use in the United States, the authors reviewed data from National Health and Nutrition Examination Survey surveys conducted between 1999 and 2010.

The researchers examined postmenopausal hormone use during 1999–2010 using cross-sectional data from 10,107 women aged 40 years and older in the National Health and Nutrition Examination Survey. They found that from 1999 through 2000, the prevalence of oral postmenopausal hormone use was 22.4% overall, 13.3% for estrogen only, and 8.3% for estrogen plus progestin. A significant decline in use of all formulations occurred from 2003–2004, when the overall prevalence decreased to 11.9%. This decline was initially limited to non-Hispanic whites; use among non-Hispanic blacks and Hispanics did not decline substantially until 2005–2006. Hormone use continued to decline through 2009–2010 across all patient demographic groups. The current prevalence is 4.7% overall, 2.7% for estrogen only, and 1.7% for estrogen plus progestin. Patient characteristics currently associated with hormone use include history of hysterectomy, non-Hispanic white race or ethnicity, and income.

A small proportion of women with no history of hysterectomy reported use of estrogen-only formulations, which generally would be contraindicated because of risk of endometrial cancer. Similar results were reported in the 1999 National Health Interview Survey using self-reported hormone use data as well as in a study using medical charts and pharmacy claims data.

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Of women reporting ever-use of any form of postmenopausal hormones, the proportion reporting the use of pills was approximately 90% throughout the study period (range 88%–94%). This suggests that changes to other forms of hormone delivery during this period are unlikely to have contributed substantially to the steep decline in use of oral preparations.

The researchers concluded that postmenopausal hormone use in the United States has declined in a sustained fashion to low levels across a wide variety of patient subgroups. They noted that additional research is needed to explore whether estrogen-only preparations are being used inappropriately by women with an intact uterus.

Take home message:
The benefits of hormone replacement therapy include elimination of hot flashes, vaginal dryness, and mood changes. In addition they reduce the risk of osteoporosis. If begun at the start of menopause HRT reduces the risk of cardiovascular. This is not the case for women who begin HRT several years after the menopause. Studies have shown that the newer low-dose estrogen patches are a safer than the older oral preparations such as Premarin, which delivered a significantly higher amount of estrogen.

Reference: Obstetrics & Gynecology

See also: Tips to revitalize sex life after 50 with traditional Chinese medicine