Menopausal hormone therapy trends before versus after 2002: impact of the Women's Health Initiative Study Results

Abstract

Objective: To better understand how to educate patients and providers about study findings relevant to treatment guidelines, we assessed pre- versus post-Women's Health Initiative (WHI) differences in menopausal hormone therapy (MHT) initiation and continuation and their correlates, and in women's reasons for initiation and discontinuation.

Methods: We analyzed survey data from up to 14 approximately annual visits over 17 years (1996-2013) from 3,018 participants in the Study of Women's Health Across the Nation, a prospective cohort study. We used logistic regression to compare pre- versus post-WHI associations of covariates with MHT initiation and continuation, and to compare pre- versus post-WHI reasons for initiation and continuation.

Results: MHT initiation dropped from 8.6% pre-WHI to 2.8% post-WHI (P < 0.0001), and the corresponding decrease in MHT continuation was 84.0% to 62.0% (P < 0.0001). Decreases in MHT initiation and continuation occurred across a range of participant subgroups, consistent with wide dissemination of post-WHI recommendations. However, contrary to current guidelines, we found large declines in MHT use in subgroups for whom MHT is often recommended, that is, younger women and those with more vasomotor symptoms. Post-WHI, women's reasons for MHT initiation and discontinuation reflected concerns highlighted by WHI results. The largest declines in initiation reasons were for reducing risks of osteoporosis and heart disease, whereas the largest increases in discontinuation reasons were for media reports and provider advice.

Conclusions: Immediate post-WHI recommendations for MHT use were widely adopted. MHT risks documented in older women, however, may have led younger symptomatic women to forgo MHT for symptom relief.

Figure 1a:

Menopausal hormone therapy initiation before and after Women’s Health Initiative July 2002 announcement by sociodemographic characteristics p-values for interaction between pre-WHI versus post-WHI and characteristic indicated by *p<0.05, **p<0.01, ***p<0.001

Figure 1b:

Menopausal hormone therapy initiation before and after Women’s Health Initiative July 2002 announcement by prior vasomotor symptom frequency and MHT use p-value for interaction between pre-WHI versus post-WHI and characteristic indicated by **p<0.01

Figure 1c:

Menopausal hormone therapy initiation before and after Women’s Health Initiative July 2002 announcement by menopausal stage

Figure 2a:

Menopausal hormone therapy continuation before and after Women’s Health Initiative July 2002 announcement by sociodemographic characteristics

Figure 2b:

Menopausal hormone therapy continuation before and after Women’s Health Initiative July 2002 announcement by prior vasomotor symptom frequency and MHT use p-values for interaction between pre-WHI versus post-WHI and characteristic indicated by *p<0.05, **p<0.01

Figure 2c:

Menopausal hormone therapy continuation before and after Women’s Health Initiative July 2002 announcement by menopausal stage

Figure 3a:

Reasons for menopausal hormone therapy initiation before and after Women’s Health Initiative July 2002 announcement p-values for pre-WHI versus post-WHI difference indicated by *p<0.05, **p<0.01, ***p<0.001

Figure 3b:

Reasons for menopausal hormone therapy discontinuation before and after Women’s Health Initiative July 2002 announcement p-values for pre-WHI versus post-WHI difference indicated by *p<0.05, **p<0.01, ***p<0.001