Menopausal hormone therapy prescriptions remain low in US
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Key takeaways :
- In 2018 to 2019, 4% of ambulatory care visits for women aged 50 years and older documented a new or continuing systemic HT prescription.
- A prescription was more likely for women with depression or polypharmacy.
PHILADELPHIA — The number of women aged at least 50 years prescribed hormone therapy for menopause symptoms remains low, particularly for Hispanic women, despite good efficacy and safety, according to a presenter.
Prevalence of HT use was 22.4% in 1999 to 2000, said Talia Sobel, MD, NCMP, a women's health internal medicine physician at Mayo Clinic in Scottsdale, Arizona, during a presentation at the Annual Meeting of The Menopause Society.
But HT prescriptions plummeted after publication of the Women’s Health Initiative trials from 2002 to 2004 due to fears that HT increased CVD and breast cancer risks — with prevalence down to 11.9 % in 2003-2004 and 4.7% in 2009-2010.
Research since then has shown that timing of HT initiation can minimize risks while delivering effective symptom treatment, according to Sobel.
“Our study’s finding of a 4% hormone therapy prescribing rate in 2018-2019 is similar to prescribing rates in 2010 despite the advancements that have occurred in research and innovation surrounding menopause care,” Sobel told Healio. “Health care practitioners should understand that women may be underprescribed hormone therapy when it is appropriate.”
Sobel and colleagues analyzed physician-report data collected over 1 week from the 2018-2019 National Ambulatory Medical Care Survey on 5,959 health care visits, which represented approximately 24.3 million visits in multistage probability sampling. They looked at new or continuing prescriptions for systemic menopausal HT (estradiol, ethinyl estradiol and conjugated estrogen therapy, with or without progestin) for U.S. women aged 50 years and older.
Of the 5,959 ambulatory visits, 248 (4%) involved an HT prescription or continuation of therapy — 60% for estradiol only, 25% for conjugated equine estrogens alone, 12% for estrogen plus progestin and 2% for estrogen plus another agent; 2% were considered duplicate visits.
During visits when HT was prescribed or continued, 30% of women were aged 50 to 60 years, 41% were aged 60 to 70 years and 29% were older than 70 years; 46% of HT visits were paid by Medicare and 42% by private insurance. During visits involving HT, 2% of the women were identified as Hispanic or Latina, 90% as white, 6% as Black and 4% as other.
The only significant medical condition associated with a difference in HT prescribing was depression; 23% of HT visits mentioned depression compared with 14% of visits without HT. Polypharmacy was also associated with a higher rate of HT prescribing or continuation, according to Sobel.
Health care providers need “increased awareness of possible ethnic or racial disparities in menopause care as seen by the decreased odds of hormone therapy prescribing in non-White or Hispanic/Latina women in this study,” Sobel told Healio. “We recommend health care practitioners have shared decision-making conversations surrounding benefits vs. risks of hormone therapy with their patients.”