Trends in overall menopausal hormone therapy use have shifted in the
past decade, especially regarding overall use, popularity in certain
populations, product formulation and route of administration.
To examine changes in menopausal HT use, researchers at Stanford School
of Medicine analyzed data from the annual IMS Health National Disease and
Therapeutic Index surveys conducted from 2001 to 2009. They gauged total use
from estimated volume of visits, during which menopausal HT use was reported by
From 2001 to 2009, results indicated a 52% decrease in total reported
menopausal HT use, with numbers of reported use declining from 17.5 million to
8.3 million. During the same period, systemic use, characterized as oral,
transdermal or intramuscular, decreased 62%, from 16.3 million to 6.1 million.
The researchers also noted that, at 65%, the reduction in continuing systemic
use was greater than newly initiated systemic use (51%). Vaginal menopausal HT,
however, increased 32%, from 1.8 million in 2001 to 2.4 million in 2009.
estrogen therapy use declined 71%, from 7.5 million in 2001
to 2.1 million in 2009. In contrast, lower-dose menopausal HT use increased
from 0.7 million in 2001 to a peak of 1.9 million in 2004 before stabilizing at
1.3 million in 2009.
When assessed by age, data showed the greatest decrease in menopausal HT
use — 64% — among women aged 60 years or older. Even so, use in women
aged younger than 50 years and those aged 50 to 59 years declined substantially
as well (59% and 60%, respectively).
Obstetrician/gynecologists were less likely to change their practices,
and therefore, overall menopausal HT visits to these physicians increased from
72% to 82% between 2001 and 2009.
The results reflect changes in guidelines for
menopausal HT use, but the researchers emphasized the
importance of future studies that provide more detailed information on risks
and benefits of different types of menopausal HT use in various populations.
Disclosure: The researchers report no relevant financial
This is a very interesting report. It indicates a trend toward using the lowest amount of hormone therapy required to treat the symptom, and this is consistent with good medical practice. FDA guidelines for approval of new products always ask the pharmaceutical company to find the lowest dose that treats the problem, and that is what we are seeing happen here. It has been happening for decades with regard to hormones. The first oral contraceptive pill was very high-dose. Now we have the lowest dose possible for preventing conception. We are seeing even more progress with HT toward using the lowest amount that will treat the problem. In cases of vaginal dryness, for example, there are several different low dose vaginal estrogen treatments that are available.
As women get older, they are more susceptible to strokes, myocardial infarctions and blood clots in the legs and lungs. Oral estrogen appears to increase the occurrence of these adverse events, so HT use in older women is going to be much less common than in younger postmenopausal women.
– Margery Gass, MD, NCMP
Executive Director of the North American Menopause Society
Consultant, Cleveland Clinic
Disclosure: Dr. Gass reports no relevant financial disclosures.