HT use decreased following results of WHI study

20th Annual North American Menopause Society Meeting

Researchers identified a decrease in the use of hormone therapy among physicians following the results of the Women’s Health Initiative study — suggesting a need for further education on low-dose, transdermal hormone therapy options.

Sharon M. Wang, PharmD, MS, of MedImpact Healthcare Systems Inc. in San Diego, and colleagues conducted a retrospective database analysis using pharmacy claims and eligibility data from MedImpact between 2002 and 2007. The results were presented at the 20th Annual North American Menopause Society Meeting, held in San Diego.

Women included in the study had at least one prescription claim for oral or transdermal HT containing estrogen. The volumes of HT claims per quarter by prescriber specialty, dose, and route of administration (oral or transdermal) were assessed. Dose was categorized as low or standard according to NAMS guidelines.

Results indicated a 72% decrease in HT prescription claims volume by the end of 2007. "In the second quarter of 2002, approximately 94% of the overall HT claims were standard dose; however, by the fourth quarter of 2007, the proportion of claims for standard-dose HT had decreased to 77%," the researchers wrote.

However, the researchers observed a simultaneous increase in transdermal HT use from 8% in the second quarter of 2002 to 19% by the end of 2007.

The proportion of prescription claims for low-dose HT increased from 6% in 2002 to 23% in 2007 for both obstetrics and gynecology physicians and non-obstetrics and gynecology physicians.

However, 25% of claims for low-dose HT were written by non-obstetrics and gynecology physicians vs. 20% of claims written by obstetrics and gynecology physicians in 2007. The proportion of claims written for transdermal HT, however, was higher for obstetrics and gynecology physicians (26%) compared with those written by non-obstetrics and gynecology (15%) in 2007. – by Jennifer Southall

For more information:

Wang SM. P-11. Presented at: the 20th Annual North American Menopause Society Meeting; Sept. 30-Oct.3, 2009; San Diego.

The findings of this study suggest that physician prescribing has been strongly impacted by the findings of the WHI study, which demonstrated increased long-term risk for breast cancer and venous thromboembolic disease as well as cardiovascular disease among sustained users of postmenopausal estrogen therapy. Major findings of this study include an overall 72% decrease in total prescriptions for HT, and among the remaining prescriptions for HT, a trend toward prescribing of low-dose HT. It already seemed clear that the ‘frost was off the pumpkin’ with regard to the notion that HT was a panacea for all that ailed our female patients in the postmenopausal years, but this study nicely documents the magnitude of the reaction from prescribing physicians. Now, the residual question might be whether or not the pendulum has swung too far toward under-prescribing and whether some intensely symptomatic patients with menopausal hot flashes disrupting their quality of life are being denied potentially helpful treatment. I would love to see the Wang study results followed up with an attitude survey of physicians regarding when HT treatment would be appropriate and for what duration.

– Stephen A. Brietzke, MD

Endocrine Today Editorial Board member