Following the Women’s Health Initiative (WHI; ClinicalTrials.gov Identifier, NC00000611) trial announcement regarding health concerns surrounding estrogen-progestin therapy, the number of prescriptions for menopausal hormone therapy (MHT) and continuation of MHT decreased, according to research published in Menopause.
A group of US-based researchers assessed the differences between pre- and post-WHI MHT initiation and continuation to understand how to teach patients and clinicians about the study findings pertaining to treatment guidelines.
The investigators evaluated survey data from the Study of Women’s Health Across the Nation, a prospective cohort study, for 3018 women with no more than 14 nearly annual visits from 1996 to 2013. Using logistic regression, they compared pre- and post-WHI associations of covariates with MHT initiation and continuation and associated reasons for each.
Results suggested a decrease in MHT initiation from 8.6% (pre-WHI) to 2.8% (post-WHI) as well as a decrease in MHT continuation from 84.0% (pre-WHI) to 62.0% (post-WHI). These results were seen across varying participant subgroups and were consistent with a wide variety of post-WHI recommendations.
In contrast to the current guidelines, there was a large drop in MHT use among younger women and women with more vasomotor symptoms. Discontinued MHT use was most often due to concerns raised following release of the WHI results. Use of MHT for osteoporosis and heart disease risk reduction decreased significantly from pre-WHI to post-WHI, and media reports and advice from clinicians were responsible for the largest increases in MHT discontinuation.
“The results of this analysis support the need for more education about personalized risk/benefit profiles for women and providers as MHT research translates to public health recommendations, to ensure evidence-based care of women though menopause and beyond,” the authors concluded.
Crawford SL, Crandall CJ, Derby CA, et al. Menopausal hormone therapy trends before versus after 2002: impact of the Women’s Health Initiative Study Results [published online December 21, 2018]. Menopause. doi:10.1097/GME.0000000000001282