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

Sybil L. Crawford, Carolyn J. Crandall, Carol A. Derby, Samar R.El Khoudary, L Elaine Waetjen, Mary Fischer, Hadine Joffe

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)588-597
Number of pages10
JournalMenopause (New York, N.Y.)
Volume26
Issue number6
DOIs
StatePublished - Dec 21 2018

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Women's Health
Hormones
Therapeutics
Guidelines
Osteoporosis
Heart Diseases
Cohort Studies
Logistic Models
Prospective Studies

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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Menopausal hormone therapy trends before versus after 2002 : impact of the Women's Health Initiative Study Results. / Crawford, Sybil L.; Crandall, Carolyn J.; Derby, Carol A.; Khoudary, Samar R.El; Waetjen, L Elaine; Fischer, Mary; Joffe, Hadine.

In: Menopause (New York, N.Y.), Vol. 26, No. 6, 21.12.2018, p. 588-597.

Research output: Contribution to journalArticle

Crawford, Sybil L. ; Crandall, Carolyn J. ; Derby, Carol A. ; Khoudary, Samar R.El ; Waetjen, L Elaine ; Fischer, Mary ; Joffe, Hadine. / Menopausal hormone therapy trends before versus after 2002 : impact of the Women's Health Initiative Study Results. In: Menopause (New York, N.Y.). 2018 ; Vol. 26, No. 6. pp. 588-597.
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AB - 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.

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